Division of Cardiology, University of Illinois Hospitals and Health Sciences System, Jesse Brown VA Medical Center, Chicago, IL, USA.
Clin Cardiol. 2013 Jul;36(7):372-7. doi: 10.1002/clc.22134. Epub 2013 May 13.
Many military veterans in the United States with coronary artery disease continue to smoke despite undergoing percutaneous coronary intervention (PCI). Previous studies have described improved cardiovascular outcomes in smokers, the so-called "smokers' paradox." In this study, we examined the effects of smoking on cardiovascular outcomes following PCI.
Do patients who smoke have different post-PCI outcomes than nonsmokers?
All patients who underwent PCI at a single US Veterans Administration hospital from 2004 to 2009 were followed. Outcomes of interest included myocardial infarction, unplanned coronary intervention, unplanned cardiac hospitalization, death, and a composite of events for 6 months after PCI. Changes in traditional risk factors were also assessed.
Unadjusted analysis revealed that in almost all categories, smokers had lower incidence of adverse events than nonsmokers. However, after adjusting for the older age of the nonsmokers, no favorable statistical trend toward smokers was seen. Significant improvement in blood pressure and lipid levels were seen in both groups.
After adjusting for differences in age, there did not appear to be any protective effect of smoking on cardiovascular outcomes following PCI. Smokers achieved similar degrees of risk factor optimization during the follow-up period as their nonsmoker counterparts. Aggressive efforts to decrease the prevalence of smoking must be maintained.
尽管美国许多患有冠状动脉疾病的退伍军人已经接受了经皮冠状动脉介入治疗（PCI），但他们仍继续吸烟。先前的研究描述了吸烟对吸烟者心血管结局的改善，即所谓的“吸烟者悖论”。在这项研究中，我们检查了吸烟对 PCI 后心血管结局的影响。
与不吸烟者相比，吸烟患者的 PCI 后结局是否不同？
对 2004 年至 2009 年期间在美国一家退伍军人事务部医院接受 PCI 的所有患者进行随访。感兴趣的结局包括心肌梗死、计划外冠状动脉介入、计划外心脏住院、死亡以及 PCI 后 6 个月的复合事件。还评估了传统危险因素的变化。
未校正分析显示，在几乎所有类别中，吸烟者的不良事件发生率均低于不吸烟者。然而，在调整了不吸烟者年龄较大的因素后，并未发现吸烟者具有统计学上的有利趋势。两组患者的血压和血脂水平均显著改善。
在调整年龄差异后，吸烟似乎并未对 PCI 后心血管结局产生任何保护作用。在随访期间，吸烟者实现了与非吸烟者相当程度的危险因素优化。必须继续积极努力降低吸烟率。
