El-Meouch Nedim Márton, Ferenci Tamás, Jánosi András
Közgazdaságtudományi Kar, Budapesti Corvinus Egyetem Budapest.
Neumann János Informatikai Kar, Élettani Szabályozások Kutatóközpont, Óbudai Egyetem Budapest.
Orv Hetil. 2018 Apr;159(14):557-565. doi: 10.1556/650.2018.31028.
The strong, positive relationship between smoking and myocardial infarction was proven in the 1960s and 1970s. The prognostic significance of smoking in the acute phase of the infarction, and later in patients who survive the acute phase is, however, not clear. Numerous international studies focus on the phenomenon called the "smoker's paradox", which means that smokers have a lower mortality rate after suffering myocardial infarction than non-smokers. Although in many cases smoking does not have a positive effect on survival after controlling for confounders, an international consensus has not been reached regarding this issue.
The aim of this paper was to investigate whether the paradox effect exists in the case of Hungarian patients after controlling for the patients' risk profiles.
The database used for the research was based on the 2014-2016 data of the Hungarian Myocardial Infarction Registry (n = 20 811) supervised by the Gottsegen György National Institute of Cardiology. The present analysis uses multivariate methodology to adjust for confounding: logistic regression is used for the short-term survival and survival analysis - with Cox proportional hazards model and Accelerated Failure Time models - is used for the long-term survival. Age, sex, performing of PCI, type of infarction (ST-elevation or not), creatinine abnormality, need for prehospital reanimation, cardiogenic shock and the presence of several comorbidities and medical history data were controlled for in the multivariate analysis.
Both the short term - 30 day - mortality (OR = 1.517, 99% confidence interval: 1.229-1.872) and the long term mortality (HR = 1.395, 99% confidence interval: 1.232-1.579) were worse for smokers than non-smokers after adjusting for the abovementioned factors.
The "smoker's paradox" cannot be observed in the case of Hungarian patients, moreover smoking in itself is associated with worse prognosis. Orv Hetil. 2018; 159(14): 557-565.
吸烟与心肌梗死之间强烈的正相关关系在20世纪60年代和70年代得到证实。然而，吸烟在梗死急性期以及急性期存活患者后期的预后意义尚不清楚。许多国际研究聚焦于所谓的“吸烟者悖论”现象，即吸烟者心肌梗死后的死亡率低于非吸烟者。尽管在许多情况下，控制混杂因素后吸烟对生存率并无积极影响，但关于这一问题尚未达成国际共识。
本文旨在研究在控制患者风险特征后，匈牙利患者是否存在悖论效应。
本研究使用的数据库基于由戈特塞根·久尔吉国家心脏病学研究所监督的匈牙利心肌梗死登记处2014 - 2016年的数据（n = 20811）。本分析采用多变量方法来调整混杂因素：短期生存采用逻辑回归，长期生存采用生存分析——使用Cox比例风险模型和加速失效时间模型。多变量分析中控制了年龄、性别、PCI实施情况、梗死类型（ST段抬高与否）、肌酐异常、院前复苏需求、心源性休克以及几种合并症和病史数据。
在调整上述因素后，吸烟者的短期（30天）死亡率（OR = 1.517，99%置信区间：1.229 - 1.872）和长期死亡率（HR = 1.395，99%置信区间：1.232 - 1.579）均高于非吸烟者。
在匈牙利患者中未观察到“吸烟者悖论”，此外吸烟本身与更差的预后相关。《匈牙利医学周报》。2018年；159(14): 557 - 565。
