Xue Chao, Bian Lin, Xie Yu Shui, Yin Zhao Fang, Xu Zuo Jun, Chen Qi Zhi, Zhang Hui Li, Wang Chang Qian
Department of Cardiology, Shanghai Ninth People's Hospital, Jiao Tong University School of Medicine, Shanghai, 200011, People's Republic of China.
Health Qual Life Outcomes. 2017 Jan 3;15(1):1. doi: 10.1186/s12955-016-0578-4.
Smoking has been shown to reduce health-related quality of life (HRQOL) in patients with coronary artery disease (CAD) undergoing percutanous coronary intervention (PCI) either by means of balloon angioplasty or with the use of bare-metal stents (BMS). Drug-eluting stents (DES) have now been widely used and are related to substantial reduction of restenosis and significantly improved HRQOL compared with BMS. This study aimed to evaluate the effects of smoking on HRQOL in patients after PCI in DES era.
A cohort of 649 patients admitted for CAD and treated with drug-eluting stents were included in this prospective, observational study. Patients were classified as non-smokers (n = 351, 54.1%), quitters (n = 126, 19,4%), or persistent smokers (n = 172, 26.5%) according to their smoking status at the time they first admitted to hospital and during the first year of follow-up. Each patient was prospectively interviewed at baseline, 6 months and 1 year following PCI. HRQOL was assessed with the use of Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36).
For the overall population, HRQOL scores at 1-year follow-up were significantly higher than baseline for all 8 domains. At 1-year follow-up, the HRQOL scores in persistent smokers were still lower than that in non-smokers in 6 domains except for bodily pain and mental health, and than that in quitters in 5 domains except for bodily pain, role emotional and mental health. There were no significant differences with regard to the scores between non-smokers and quitters except role emotional for which non-smokers had higher scores. After adjustment, persistent smokers demonstrated significantly less improvements in HRQOL than non-smokers in 6 domains except for bodily pain and social functioning and significantly less improvement than quitters for general health. Improvements of quitters were comparable to that of non-smokers in all domains. Multivariate linear regression analyses showed persistent smoking was an independent risk factor for PCS and MCS improvements.
Persistent smoking substantially diminishes the potential quality-of-life benefits of DES. Efforts should be made to promote smoking cessation after DES implantation which could greatly improve the health quality outcomes.
研究表明，吸烟会降低接受经皮冠状动脉介入治疗（PCI）的冠心病（CAD）患者的健康相关生活质量（HRQOL），PCI治疗方式包括球囊血管成形术或使用裸金属支架（BMS）。药物洗脱支架（DES）现已广泛应用，与BMS相比，可显著降低再狭窄率并显著改善HRQOL。本研究旨在评估DES时代吸烟对PCI术后患者HRQOL的影响。
本前瞻性观察性研究纳入了649例因CAD入院并接受药物洗脱支架治疗的患者。根据患者首次入院时及随访第一年的吸烟状况，将患者分为非吸烟者（n = 351，54.1%）、戒烟者（n = 126，19.4%）或持续吸烟者（n = 172，26.5%）。在PCI术后基线、6个月和1年时对每位患者进行前瞻性访谈。使用医学结局研究36项简短健康调查（SF - 36）评估HRQOL。
对于总体人群，1年随访时所有8个领域的HRQOL评分均显著高于基线。在1年随访时，除身体疼痛和心理健康外，持续吸烟者在6个领域的HRQOL评分仍低于非吸烟者，除身体疼痛、角色情感和心理健康外，在5个领域的评分低于戒烟者。非吸烟者和戒烟者之间的评分除角色情感（非吸烟者得分更高）外无显著差异。调整后，除身体疼痛和社会功能外，持续吸烟者在6个领域的HRQOL改善明显低于非吸烟者，在总体健康方面改善明显低于戒烟者。戒烟者在所有领域的改善与非吸烟者相当。多因素线性回归分析显示持续吸烟是PCS和MCS改善的独立危险因素。
持续吸烟会显著降低DES带来的潜在生活质量益处。应努力促进DES植入后戒烟，这可极大改善健康质量结局。
