Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 69978, Israel.
J Am Coll Cardiol. 2009 Dec 15;54(25):2382-7. doi: 10.1016/j.jacc.2009.09.020.
We compared long-term survival after acute myocardial infarction (AMI) of never-smokers, pre-AMI quitters, post-AMI quitters, and persistent smokers and assessed whether cigarette reduction among persistent smokers is associated with lower mortality.
Quitting smoking has been shown to improve outcome after AMI. However, longitudinal cohort data with repeated assessments of smoking and information on multiple confounders are lacking. Moreover, little is known about the importance, if any, of reductions in the amount smoked.
Consecutive patients < or = 65 years of age, discharged from 8 hospitals in central Israel after first AMI in 1992 to 1993, were followed through 2005. Extensive data, including self-reported smoking habits, were obtained at baseline and 4 times during follow-up. Cox proportional hazards regressions were used to assess the hazard ratios (HRs) for death associated with smoking categories modeled as time-dependent variables.
At baseline, smokers were younger, more likely to be male, and had a lower prevalence of hypertension and diabetes than nonsmokers. Over a median follow-up of 13.2 years, 427 deaths occurred in 1,521 patients. The multivariable-adjusted HRs for mortality were 0.57 (95% confidence interval [CI]: 0.43 to 0.76) for never-smokers, 0.50 (95% CI: 0.36 to 0.68) for pre-AMI quitters, and 0.63 (95% CI: 0.48 to 0.82) for post-AMI quitters, compared with persistent smokers. Among persistent smokers, upon multivariable adjustment including pre-AMI intensity, each reduction of 5 cigarettes smoked daily after AMI was associated with an 18% decline in mortality risk (p < 0.001).
Smoking cessation either before or after AMI is associated with improved survival. Among persistent smokers, reducing intensity after AMI appears to be beneficial.
我们比较了急性心肌梗死（AMI）后从不吸烟者、AMI 前戒烟者、AMI 后戒烟者和持续吸烟者的长期生存情况，并评估了持续吸烟者减少吸烟量是否与死亡率降低有关。
戒烟已被证明可改善 AMI 后的预后。然而，缺乏具有多次评估吸烟情况和多个混杂因素信息的纵向队列数据。此外，对于吸烟量减少的重要性（如果有的话）知之甚少。
连续纳入年龄≤65 岁的患者，这些患者在 1992 年至 1993 年期间于以色列中部 8 家医院首次发生 AMI 后出院，随访至 2005 年。在基线和随访期间的 4 次随访中获得了包括自我报告的吸烟习惯在内的广泛数据。使用 Cox 比例风险回归来评估与吸烟类别相关的死亡风险比（HR），将这些吸烟类别建模为时间依赖性变量。
在基线时，吸烟者年龄较小，男性更多，且高血压和糖尿病的患病率低于不吸烟者。在中位随访 13.2 年期间，1521 例患者中有 427 例死亡。多变量调整后的死亡率 HR 为从不吸烟者 0.57（95%置信区间[CI]：0.43 至 0.76），AMI 前戒烟者 0.50（95% CI：0.36 至 0.68），AMI 后戒烟者 0.63（95% CI：0.48 至 0.82），与持续吸烟者相比。在包括 AMI 前强度的多变量调整后，持续吸烟者在 AMI 后每天减少 5 支烟与死亡率风险降低 18%相关（p<0.001）。
AMI 前或后戒烟与生存改善相关。在持续吸烟者中，AMI 后降低吸烟强度似乎有益。
