Huang Xingtao, Wang Xuedong, Zou Yongpeng, Chen Shuyuan, Zhang Ruoxi, Li Lulu, Yu Bo, Hou Jingbo
Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
Am J Cardiol. 2017 Oct 15;120(8):1279-1284. doi: 10.1016/j.amjcard.2017.07.011. Epub 2017 Jul 24.
There is debate regarding whether smoking results in microstructural changes after stenting. The aim of this study was to evaluate the microstructural changes after stenting in patients with different smoking statuses. We retrospectively identified 220 sirolimus-eluting stents in 179 patients who underwent follow-up optical coherence tomography examination 12 months after sirolimus stenting. Subjects were classified as current smokers (CS, n = 31), smoking cessation ≤1 year (n = 36), smoking cessation >1 year (SC > 1Y, n = 27), and never smokers (NS, n = 85). The neointimal hyperplasia (NIH) area was larger in CS than in NS (1.04 ± 0.72 mm vs 0.96 ± 0.68 mm; p = 0.04). The incidence of lipid-laden neointima was lower in SC > 1Y patients (1.6%) than in all other patients (NS: 3.9%, p = 0.002; CS: 3.0%, p = 0.073; SC1Y: 5.0%, p <0.001). Smoking cessation level was negatively correlated with NIH (B = -0.154; 95% confidential interval -0.187, -0.121; p <0.001) and independently associated with the presence of homogeneous neointima (odds ratio: 1.414; 95% confidential interval 1.145, 1.745; p = 0.001). The incidence of malapposed struts was higher in CS than in NS (3.2% vs 1.6%; p = 0.004). However, smoking cessation patients showed a decreased trend in the incidence of malapposed struts (p = 0.0003). In conclusion, continued smoking increases NIH and the incidence of malapposed struts. However, smoking cessation slows down NIH progression and decreases the incidence of malapposed struts. Smoking cessation promotes vascular healing after stenting.
关于支架置入术后吸烟是否会导致微观结构改变存在争议。本研究的目的是评估不同吸烟状态患者支架置入术后的微观结构变化。我们回顾性分析了179例接受西罗莫司支架置入术后12个月光学相干断层扫描随访检查患者的220个西罗莫司洗脱支架。受试者分为当前吸烟者（CS，n = 31）、戒烟≤1年者（n = 36）、戒烟>1年者（SC>1Y，n = 27）和从不吸烟者（NS，n = 85）。CS组的新生内膜增生（NIH）面积大于NS组（1.04±0.72mm对0.96±0.68mm；p = 0.04）。SC>1Y患者中富含脂质新生内膜的发生率低于所有其他患者（NS：3.9%，p = 0.002；CS：3.0%，p = 0.073；SC1Y：5.0%，p<0.001）。戒烟水平与NIH呈负相关（B = -0.154；95%置信区间-0.187，-0.121；p<0.001），并与均匀新生内膜的存在独立相关（比值比：1.414；95%置信区间1.145，1.745；p = 0.001）。CS组贴壁不良支架的发生率高于NS组（3.2%对1.6%；p = 0.004）。然而，戒烟患者贴壁不良支架的发生率呈下降趋势（p = 0.0003）。总之，持续吸烟会增加NIH和贴壁不良支架的发生率。然而，戒烟会减缓NIH进展并降低贴壁不良支架的发生率。戒烟可促进支架置入术后血管愈合。
