van Domburg Ron T, op Reimer Wilma Scholte, Hoeks Sanne E, Kappetein Arie Pieter, Bogers Ad J J C
Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
Am Heart J. 2008 Sep;156(3):473-6. doi: 10.1016/j.ahj.2008.04.007. Epub 2008 Jun 26.
Previous studies have shown that smoking cessation after a cardiac event reduces the risk of subsequent mortality in patients, but the effect of smoking cessation in terms of prolonged life-years is not yet known.
We analyzed the 30-year clinical outcome of the first 1,041 consecutive patients (age at operation 51 years, 92% male) who successfully underwent isolated venous coronary artery bypass surgery between 1971 and 1980. All 551 smokers (53%) were included in this study. Of these, 43% stopped smoking throughout the first year whereas 57% persisted smoking.
The median follow-up was 29 years (range 26-36 years). The cumulative 10-, 20-, and 30-year survival rates were 88%, 49%, and 19%, respectively, in the group of patients who quit smoking, and only 77%, 36%, and 11%, respectively, in the persistent smokers (P < .0001). After adjusting for all baseline characteristics, smoking cessation remained an independent predictor of lower mortality (hazard ratio 0.60, 95% CI 0.48-0.72). We were able to assess the exact life expectancy by calculating the area under the Kaplan-Meier curves. Life expectancy in the quitters was 20.0 years and 17.0 years in the persistent smokers (P < .0001).
Using 30-year follow-up data, we estimated that self-reported smoking cessation after coronary artery bypass surgery was associated with a life expectancy gain of 3 years. Smoking cessation turned out to have a greater effect on reducing the risk of mortality than the effect of any other intervention or treatment.
既往研究表明，心脏事件后戒烟可降低患者后续死亡风险，但戒烟对延长生命年数的影响尚不清楚。
我们分析了1971年至1980年间连续成功接受单纯静脉冠状动脉搭桥手术的前1041例患者（手术时年龄51岁，92%为男性）的30年临床结局。本研究纳入了所有551名吸烟者（53%）。其中，43%在第一年完全戒烟，而57%持续吸烟。
中位随访时间为29年（范围26 - 36年）。戒烟组患者的10年、20年和30年累积生存率分别为88%、49%和19%，而持续吸烟组分别仅为77%、36%和11%（P <.0001）。在对所有基线特征进行调整后，戒烟仍然是较低死亡率的独立预测因素（风险比0.60，95%可信区间0.48 - 0.72）。我们能够通过计算Kaplan-Meier曲线下的面积来评估确切的预期寿命。戒烟者的预期寿命为20.0年，持续吸烟者为17.0年（P <.0001）。
利用30年随访数据，我们估计冠状动脉搭桥手术后自我报告的戒烟与预期寿命增加3年相关。事实证明，戒烟在降低死亡风险方面比任何其他干预或治疗的效果都更大。
