Honda Tsuyoshi, Fujimoto Kazuteru, Miyao Yuji, Koga Hidenobu, Ishii Masanobu
Department of Cardiology, Cardiovascular Center, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan.
Department of Cardiology, Cardiovascular Center, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan.
J Cardiol. 2014 May;63(5):358-64. doi: 10.1016/j.jjcc.2013.10.007. Epub 2013 Nov 14.
Acute myocardial infarction (AMI) is prevalent and has serious consequences including re-infarction and death. Cigarette smoking is a coronary risk factor for AMI, although a "smoker's paradox" for AMI has been reported in Western countries. On the other hand, some researchers have reported that smoking is associated with subacute stent thrombosis (SAST) after AMI. However, the occurrence of this condition is not well documented in Japan. The aim of this study was to clarify how prior smoking status may affect prognosis, including SAST, in Japanese patients with AMI.
A total of 266 consecutive patients with AMI were enrolled retrospectively in the study if they had undergone emergency coronary intervention (bare metal stent) within 24h of symptom onset, and had a 5-10 month follow-up examination. The patients were divided into three groups based on their cigarette smoking status (non-smokers, past smokers, and current smokers).
Current smokers were significantly younger than the other two groups, although their levels of low density lipoprotein-cholesterol and triglyceride were significantly higher. White blood cell count and hemoglobin level on admission were also significantly higher in current smokers compared with the other two groups. The incidence of SAST was significantly higher in current smokers than in the other groups, although the occurrence of heart failure after AMI was similar in the three groups. On the other hand, improvement in left ventricular ejection fraction was observed in non-smokers and past smokers, but not in current smokers. Multiple logistic analysis revealed that current smoking was an independent risk factor for SAST (odds ratio 5.4; p<0.05). Current smokers were about five times more likely to have a SAST compared with non-smokers.
These findings indicate that current cigarette smoking predicts SAST after primary percutaneous coronary intervention for AMI in Japanese patients.
急性心肌梗死（AMI）很常见，会导致包括再梗死和死亡在内的严重后果。吸烟是AMI的一个冠状动脉危险因素，尽管西方国家报道过AMI存在“吸烟者悖论”。另一方面，一些研究人员报告称，吸烟与AMI后的亚急性支架血栓形成（SAST）有关。然而，在日本，这种情况的发生尚无充分记录。本研究的目的是阐明既往吸烟状况如何影响日本AMI患者的预后，包括SAST。
共有266例连续的AMI患者被纳入本研究，如果他们在症状发作后24小时内接受了急诊冠状动脉介入治疗（裸金属支架），并进行了5至10个月的随访检查。根据吸烟状况将患者分为三组（非吸烟者、既往吸烟者和当前吸烟者）。
当前吸烟者明显比其他两组年轻，尽管他们的低密度脂蛋白胆固醇和甘油三酯水平明显更高。与其他两组相比，当前吸烟者入院时的白细胞计数和血红蛋白水平也明显更高。当前吸烟者的SAST发生率明显高于其他组，尽管三组中AMI后心力衰竭的发生率相似。另一方面，非吸烟者和既往吸烟者的左心室射血分数有所改善，而当前吸烟者则没有。多因素逻辑分析显示，当前吸烟是SAST的独立危险因素（比值比5.4；p<0.05）。与非吸烟者相比，当前吸烟者发生SAST的可能性大约高五倍。
这些发现表明，当前吸烟可预测日本患者AMI接受直接经皮冠状动脉介入治疗后的SAST。
