Agarwal Manyoo, Agrawal Sahil, Garg Lohit, Reed Guy L, Khouzam Rami N, Ibebuogu Uzoma N
Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
Division of Cardiovascular Medicine, Department of Internal Medicine, St Luke's University Health Network, Bethlehem, PA, USA.
Ann Transl Med. 2018 Jan;6(1):2. doi: 10.21037/atm.2017.11.32.
The paradox that smokers have better clinical outcomes in cardiovascular diseases remains controversial. No literature exists studying impact of smoking on outcomes following transcatheter aortic valve replacement (TAVR).
We performed an electronic search of the 2011-2012 National Inpatient Sample (NIS) database to identify all TAVR hospitalizations. Outcomes were measured comparing smokers to non-smokers.
A total of 8,345 TAVR hospitalizations were identified with 24% being smokers. Compared to non-smokers, smokers were younger (80.4±8.8 81.4±9.2 years, P<0.001), were more often men (63.6% 47.8%, P<0.001), and had a higher disease burden. Despite a higher disease burden, smokers had lower post procedure stroke (2.8% 3.1%), hemorrhage events (28.2% 32.0%, P<0.05) and lower all cause in-hospital mortality (1.2% 5.7%, adjusted odds ratio 0.21, 95% CI: 0.13-0.32, P<0.001) compared to non-smokers.
Despite having a higher cardiovascular disease burden, smokers had better outcomes compared to non-smokers. Therefore the smoker's paradox is applicable in the TAVR cohort.
吸烟者在心血管疾病中具有更好临床结局这一矛盾现象仍存在争议。目前尚无关于吸烟对经导管主动脉瓣置换术（TAVR）后结局影响的研究文献。
我们对2011 - 2012年国家住院患者样本（NIS）数据库进行了电子检索，以确定所有TAVR住院病例。通过比较吸烟者和非吸烟者来衡量结局。
共确定了8345例TAVR住院病例，其中24%为吸烟者。与非吸烟者相比，吸烟者更年轻（80.4±8.8岁对81.4±9.2岁，P<0.001），男性比例更高（63.6%对47.8%，P<0.001），且疾病负担更高。尽管疾病负担更高，但与非吸烟者相比，吸烟者术后中风发生率更低（2.8%对3.1%）、出血事件发生率更低（28.2%对32.0%，P<0.05），且全因住院死亡率更低（1.2%对5.7%，调整后比值比0.21，95%可信区间：0.13 - 0.32，P<0.001）。
尽管吸烟者心血管疾病负担更高，但与非吸烟者相比结局更好。因此，吸烟者悖论适用于TAVR队列。
