Herz-Kreislauf-Zentrum, Segeberger Kliniken GmbH, Bad Segeberg, Germany.
Clin Res Cardiol. 2011 May;100(5):413-23. doi: 10.1007/s00392-010-0259-y. Epub 2010 Dec 1.
Cigarette smoking strongly increases morbidity and mortality from cardiovascular causes, but the relevance of smoking in patients treated with drug-eluting stents (DES) is unknown.
To assess the impact of smoking on the presentation and outcome of patients treated with DES.
We analyzed data from the prospective multicentre German Drug-Eluting Stent Registry (DES.DE) and identified 1,122 patients who had never smoked and 1,052 patients who were current smokers. Smokers were younger (56.5 vs. 69.4 years, p < 0.0001), more often males, with less frequent diabetes and hypertension compared to non-smokers. Smokers presented more often with acute coronary syndromes. After a mean follow-up of 12.5 months, smokers had both higher mortality (4.6 vs. 2.7%, p < 0.05) and myocardial infarction (MI) rates (4.9 vs. 3%, p < 0.01). There was no significant difference between smokers and non-smokers in the rate of target vessel revascularization (9.8 vs. 11.4%, p = 0.26). Major adverse cardiac and cerebrovascular events (defined as the composite of death, MI and stroke, MACCE) were higher in smokers (10.6 vs. 6.1%, p < 0.001). Moreover, after adjustment for baseline clinical and angiographic variables, smoking continued to be a strong independent predictor for MACCE (OR = 2.34, 95% CI 1.49-3.68). In a subgroup analysis, we found that the increased risk of smoking was most prominent in patients presenting with stable angina pectoris (OR = 3.71, 95% CI 1.24-2.57, p < 0.05). Smoking almost doubled the risk for MACCE in acute MI patients, though this did not reach statistical significance (adjusted OR = 1.91, 95% CI 0.93-3.94, p = 0.74).
This large multicentre DES registry provides evidence that smokers treated with DES, despite lower incidence of predisposing risk factors for atherosclerosis, experience higher rates of death and MI compared to non-smokers, particularly in the setting of stable coronary artery disease. Smoking has only marginal effects on target vessel revascularization rates in patients treated with DES.
吸烟会大大增加心血管疾病的发病率和死亡率，但在接受药物洗脱支架（DES）治疗的患者中，吸烟的相关性尚不清楚。
评估吸烟对接受 DES 治疗的患者的临床表现和结局的影响。
我们分析了前瞻性多中心德国药物洗脱支架注册研究（DES.DE）的数据，共纳入 1122 例从未吸烟的患者和 1052 例当前吸烟者。与非吸烟者相比，吸烟者年龄更小（56.5 岁 vs. 69.4 岁，p < 0.0001），男性更多，糖尿病和高血压的发病率更低。吸烟者更常出现急性冠脉综合征。平均随访 12.5 个月后，吸烟者的死亡率（4.6% vs. 2.7%，p < 0.05）和心肌梗死（MI）发生率（4.9% vs. 3%，p < 0.01）均更高。吸烟者和非吸烟者之间靶血管血运重建率（9.8% vs. 11.4%，p = 0.26）无显著差异。主要不良心脑血管事件（定义为死亡、MI 和卒中的复合事件，MACCE）在吸烟者中更高（10.6% vs. 6.1%，p < 0.001）。此外，在校正基线临床和血管造影变量后，吸烟仍然是 MACCE 的强独立预测因素（OR = 2.34，95% CI 1.49-3.68）。在亚组分析中，我们发现吸烟的风险增加在稳定型心绞痛患者中最为显著（OR = 3.71，95% CI 1.24-2.57，p < 0.05）。吸烟使急性 MI 患者发生 MACCE 的风险几乎增加了一倍，但这并未达到统计学意义（调整后的 OR = 1.91，95% CI 0.93-3.94，p = 0.74）。
这项大型多中心 DES 注册研究提供了证据，表明接受 DES 治疗的吸烟者尽管动脉粥样硬化的易患危险因素发生率较低，但与非吸烟者相比，死亡率和 MI 发生率更高，尤其是在稳定型冠心病患者中。吸烟对接受 DES 治疗的患者的靶血管血运重建率仅有轻微影响。
