Cardiovascular Department, San Filippo Neri Hospital, Rome, Italy.
Am J Cardiol. 2011 Sep 15;108(6):804-8. doi: 10.1016/j.amjcard.2011.04.033. Epub 2011 Jul 7.
The aim of the present study was to evaluate the smoking relapse rate among smokers who had become abstinent during admission for acute coronary syndromes. The association between smoking relapse and mortality was also analyzed. A cohort of 1,294 consecutive active smokers who had interrupted smoking after admission for acute coronary syndromes (1,018 men and 276 women, mean age 59.7 ± 12.3 years) was followed up for 12 months after the index admission. All patients received a brief in-hospital smoking cessation intervention consisting of repeated counseling sessions. During follow-up, 813 patients (62.8%) resumed regular smoking (median interval to relapse 19 days, interquartile range 9 to 76). Increasing age (hazard ratio [HR] 1.034 per year, 95% confidence interval [CI] 1.028 to 1.039, p = 0.001) and female gender (HR 1.23, 95% CI 1.09 to 1.42, p = 0.03) were independent predictors of smoking relapse. Patients enrolled in a cardiac rehabilitation program (HR 0.74, 95% CI 0.51 to 0.91, p = 0.02) and those with diabetes (HR 0.79, 95% CI 0.68 to 0.94, p = 0.03) were more likely to remain abstinent. During follow-up, 97 patients died (1-year probability of death 0.075, 95% CI 0.061 to 0.090). Multivariate analysis with the Cox proportional hazard regression method, including smoking relapse as a time-dependent covariate, demonstrated that, after adjustment for patient demographics, the clinical history features and variables related to the index event, the resumption of smoking was an independent predictor of total mortality (HR 3.1, 95% CI 1.3 to 5.7, p = 0.004). In conclusion, smoking relapse after acute coronary syndromes is associated with increased mortality, and counseling interventions should be integrated into the postdischarge support to reduce the negative effects of smoking resumption.
本研究旨在评估在因急性冠状动脉综合征住院期间戒断吸烟的吸烟者中再次吸烟的复发率。还分析了吸烟复发与死亡率之间的关系。对 1294 名连续的活跃吸烟者进行了随访，这些吸烟者在因急性冠状动脉综合征入院后中断了吸烟（1018 名男性和 276 名女性，平均年龄 59.7 ± 12.3 岁），在指数入院后进行了 12 个月的随访。所有患者均接受了简短的住院戒烟干预，包括重复咨询。在随访期间，813 名患者（62.8%）重新开始规律吸烟（中位复发间隔 19 天，四分位间距为 9 至 76 天）。年龄增长（风险比 [HR] 每年增加 1.034，95%置信区间 [CI] 1.028 至 1.039，p = 0.001）和女性（HR 1.23，95%CI 1.09 至 1.42，p = 0.03）是吸烟复发的独立预测因素。参加心脏康复计划的患者（HR 0.74，95%CI 0.51 至 0.91，p = 0.02）和患有糖尿病的患者（HR 0.79，95%CI 0.68 至 0.94，p = 0.03）更有可能保持不吸烟。在随访期间，有 97 名患者死亡（1 年死亡率为 0.075，95%CI 0.061 至 0.090）。使用 Cox 比例风险回归方法进行的多变量分析，包括将吸烟复发作为时变协变量，表明在调整患者人口统计学特征、临床病史特征和与指数事件相关的变量后，恢复吸烟是总死亡率的独立预测因素（HR 3.1，95%CI 1.3 至 5.7，p = 0.004）。总之，急性冠状动脉综合征后吸烟复发与死亡率增加有关，应将咨询干预措施纳入出院后支持，以减少吸烟复发的负面影响。
