Elosua Roberto, Vega Gema, Rohlfs Izabella, Aldasoro Elena, Navarro Carmen, Cabades Adolfo, Demissie Serkalem, Segura Antonio, Fiol Miquel, Moreno-Iribas Concepción, Echanove Ildefonso, Tormo María José, Arteagoitia José María, Sala Joan, Marrugat Jaume
Lipids and Cardiovascular Epidemiology Unit, IMIM, Barcelona, Spain.
Eur J Cardiovasc Prev Rehabil. 2007 Aug;14(4):561-7. doi: 10.1097/HJR.0b013e32804955b3.
Smoking is a risk factor for coronary heart disease, but it has been associated with better short-term prognosis in hospitalized patients with acute myocardial infarction. The aims of this study were to determine the association between smoking and myocardial infarction 28-day case-fatality in hospitalized patients and at the population level; and, whether smokers presenting with fatal myocardial infarction are more likely to die before reaching a hospital.
Population-based myocardial infarction registry, carried out in 1997-1998 in seven regions of Spain, used standardized methods to find and analyze suspected myocardial infarction patients (10 654 patients; 7796 hospitalized). Four categories of smoking status were defined: never-smokers, former smokers for more than 1 year, former smokers for less than 1 year, and current smokers.
The main end-point was 28-day case-fatality, found to be 20.1, 17.1, 15.6, and 8.9%, in the four smoking status categories, respectively, for hospitalized patients; and 37.4, 33.0, 24.5, and 23.2%, respectively, at population level. Hospitalized current smokers had lower age, sex, and comorbidity-adjusted 28-day case-fatality than never-smokers (odds ratio=0.71; 95% confidence interval: 0.56-0.90). This association held at population level (odds ratio=0.68; 95% confidence interval: 0.60-0.76), in which former smoking was also associated with lower case-fatality. In fatal cases, recent former smokers presented a lower risk of out-of-hospital death than never-smokers (odds ratio=0.47; 95% confidence interval: 0.29-0.77), whereas current smoking was marginally associated with out-of-hospital death (odds ratio=1.22; 95% confidence interval: 0.99-1.50).
Current smoking is associated with lower 28-day case-fatality in hospitalized myocardial infarction patients. This association held at population level. Among fatal cases, smoking is associated with higher and recent former smoking with lower risk of dying out-of-hospital.
吸烟是冠心病的一个危险因素，但它与急性心肌梗死住院患者较好的短期预后相关。本研究的目的是确定住院患者以及人群层面上吸烟与心肌梗死28天病死率之间的关联；以及，出现致命性心肌梗死的吸烟者在到达医院之前死亡的可能性是否更高。
1997年至1998年在西班牙七个地区开展了基于人群的心肌梗死登记研究，采用标准化方法查找和分析疑似心肌梗死患者（10654例患者；7796例住院患者）。定义了四类吸烟状况：从不吸烟者、戒烟超过1年者、戒烟不足1年者和当前吸烟者。
主要终点是28天病死率，住院患者中，四类吸烟状况的28天病死率分别为20.1%、17.1%、15.6%和8.9%；在人群层面上分别为37.4%、33.0%、24.5%和23.2%。住院的当前吸烟者经年龄、性别和合并症调整后的28天病死率低于从不吸烟者（比值比=0.71；95%置信区间：0.56-0.90）。这种关联在人群层面也成立（比值比=0.68；95%置信区间：0.60-0.76），其中既往吸烟也与较低的病死率相关。在致命病例中，近期戒烟者院外死亡风险低于从不吸烟者（比值比=0.47；95%置信区间：0.29-0.77），而当前吸烟与院外死亡仅有微弱关联（比值比=1.22；95%置信区间：0.99-1.50）。
当前吸烟与住院心肌梗死患者较低的28天病死率相关。这种关联在人群层面也成立。在致命病例中，吸烟与较高的院外死亡风险相关，而近期戒烟与较低的院外死亡风险相关。
Zotero 插件