Gao Lei, Park Seung-Jung, Jang Yangsoo, Lee Stephen, Tian Jinwei, Minami Yoshiyasu, Jia Haibo, Ong Daniel, Soeda Tsunenari, Vergallo Rocco, Lee Hang, Yu Bo, Uemura Shiro, Jang Ik-Kyung
Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Am J Cardiol. 2015 Mar 15;115(6):751-7. doi: 10.1016/j.amjcard.2014.12.038. Epub 2015 Jan 6.
Cigarette smoking is known to be deleterious to patients with coronary artery disease; however, the effect of smoking on vascular responses after coronary drug-eluting stent implantation is unknown. We sought to examine vascular response after sirolimus-eluting stent implantation in patients with ongoing smoking using optical coherence tomography, compared with former smokers and nonsmokers. We identified 181 sirolimus-eluting stents in 140 subjects who underwent follow-up optical coherence tomography imaging. Subjects were divided into 3 groups: current smokers (n = 28), former smokers (n = 35), and nonsmokers (n = 77). Stent strut coverage, neointimal characteristics, and strut malapposition were evaluated. The incidence of uncovered stent struts was significantly higher in nonsmokers compared with current smokers (13.3 ± 13.3% vs 6.7 ± 8.3%; p = 0.001). On qualitative evaluation of neointimal morphology, the prevalence of heterogeneous neointima was higher in current smokers (71.9%) than in former smokers (36.0%) or nonsmokers (10.1%) (p = 0.004 and p <0.001, respectively). There was no difference in the incidence of malapposition among the 3 groups. Multivariate modeling showed that current smoking was negatively associated with the presence of uncovered struts (odds ratio 0.33; 95% confidence interval 0.14 to 0.79; p = 0.013) and positively associated with the presence of heterogeneous neointima (odds ratio 9.47; 95% confidence interval 3.79 to 23.72; p <0.001). In conclusion, the incidence of strut coverage was higher in current smokers compared with nonsmokers. However, the pattern of neointima was more heterogeneous in current smokers.
众所周知，吸烟对冠心病患者有害；然而，吸烟对冠状动脉药物洗脱支架植入术后血管反应的影响尚不清楚。我们试图通过光学相干断层扫描，研究正在吸烟的患者在西罗莫司洗脱支架植入后的血管反应，并与既往吸烟者和不吸烟者进行比较。我们在140名接受随访光学相干断层扫描成像的受试者中识别出181个西罗莫司洗脱支架。受试者分为3组：当前吸烟者（n = 28）、既往吸烟者（n = 35）和不吸烟者（n = 77）。评估支架小梁覆盖率、新生内膜特征和小梁贴壁不良情况。与当前吸烟者相比，不吸烟者未覆盖支架小梁的发生率显著更高（13.3±13.3%对6.7±8.3%；p = 0.001）。在对新生内膜形态进行定性评估时，当前吸烟者中异质性新生内膜的患病率高于既往吸烟者（36.0%）或不吸烟者（10.1%）（分别为p = 0.004和p <0.001）。3组之间贴壁不良的发生率没有差异。多变量模型显示，当前吸烟与未覆盖小梁的存在呈负相关（比值比0.33；95%置信区间0.14至0.79；p = 0.013），与异质性新生内膜的存在呈正相关（比值比9.47；95%置信区间3.79至23.72；p <0.001）。总之，与不吸烟者相比，当前吸烟者的小梁覆盖率更高。然而，当前吸烟者的新生内膜模式更具异质性。
