Thoraxcenter, Erasmus Medical Centre, Rotterdam, the Netherlands; Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Sheffield Teaching Hospitals and the University of Sheffield, Sheffield, United Kingdom.
J Am Coll Cardiol. 2015 Mar 24;65(11):1107-15. doi: 10.1016/j.jacc.2015.01.014.
Cigarette smoking is a well-known risk factor for development of coronary artery disease (CAD). However, some studies have suggested a "smoker's paradox," meaning neutral or favorable outcomes in smokers who have developed CAD, especially myocardial infarction (MI).
The study aimed to examine the association of smoking status with clinical outcomes in the randomized controlled SYNTAX (SYNergy Between PCI With TAXUS and Cardiac Surgery) trial at 5-year follow-up.
Detailed smoking history was collected at baseline, 6-month, 1-year, 3-year, and 5-year follow-up. The composite endpoints included death/MI/stroke (primary endpoint) plus major adverse cardiac and cerebrovascular events (MACCE) (combination of death/MI/stroke and target lesion revascularization) according to patient smoking status. The comparison of 5-year clinical outcomes between the groups according to smoking status was performed with Cox regression using smoking status at baseline or smoking as a time-dependent covariate.
A sizeable proportion (n = 322, 17.9%) of patients had changing smoking status during 5-year follow-up. One in 5 patients with complex CAD was smoking at baseline. However, 60% stopped after revascularization while others continued to smoke. Smokers had worse clinical outcomes due to a higher incidence of recurrent MI in both revascularization arms. Smoking was an independent predictor of the composite endpoint of death/MI/stroke (hazard ratio [HR]: 1.8; 95% confidence interval [CI]: 1.3 to 2.5; p = 0.001) and MACCE (HR: 1.4; 95% CI: 1.1 to 1.7; p = 0.02).
Smoking is associated with poor clinical outcomes after revascularization in patients with complex CAD. This places further emphasis on efforts at smoking cessation to improve revascularization benefits. (SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries; NCT00114972).
吸烟是冠心病（CAD）发展的一个众所周知的危险因素。然而，一些研究表明存在“吸烟者悖论”，即在发生 CAD，特别是心肌梗死（MI）的吸烟者中，结果呈中性或有利。
本研究旨在探讨在 5 年随访时，SYNTAX（经皮冠状动脉介入治疗与心脏手术的协同作用）随机对照试验中吸烟状况与临床结局之间的关联。
在基线、6 个月、1 年、3 年和 5 年随访时收集详细的吸烟史。根据患者的吸烟状况，将复合终点包括死亡/心肌梗死/中风（主要终点）加上主要心脏和脑血管不良事件（MACCE）（死亡/心肌梗死/中风和靶病变血运重建的组合）。使用 Cox 回归比较根据基线吸烟状况或吸烟作为时间依赖性协变量的组间 5 年临床结局。
在 5 年随访期间，相当一部分（n=322，占 17.9%）患者的吸烟状况发生了变化。有复杂 CAD 的五分之一患者在基线时吸烟。然而，60%的患者在血运重建后停止吸烟，而其他人则继续吸烟。由于再血管化治疗后复发性 MI 的发生率较高，吸烟者的临床结局较差。吸烟是死亡/心肌梗死/中风复合终点的独立预测因素（危险比[HR]：1.8；95%置信区间[CI]：1.3 至 2.5；p=0.001）和 MACCE（HR：1.4；95%CI：1.1 至 1.7；p=0.02）。
在复杂 CAD 患者中，吸烟与血运重建后的不良临床结局相关。这进一步强调了努力戒烟以提高血运重建获益的必要性。（SYNTAX 研究：TAXUS 药物洗脱支架与冠状动脉旁路移植术治疗狭窄血管；NCT00114972）。
