Faculty of Health, Department of Cardiology, Örebro University, Örebro, Sweden.
Faculty of Medicine, Department of Cardiology, Lund University, Lund, Sweden.
Open Heart. 2019 Oct 15;6(2):e001109. doi: 10.1136/openhrt-2019-001109. eCollection 2019.
To assess the risk of future death and cardiac events following percutaneous coronary intervention (PCI) in patients using smokeless tobacco, snus, compared with patients not using snus at admission for a first PCI.
The Swedish Coronary Angiography and Angioplasty Registry is a prospective registry on coronary diagnostic procedures and interventions. A total of 74 958 patients admitted for a first PCI were enrolled between 2009 and 2018, 6790 snus users and 68 168 not using snus. We used Cox proportional hazards regression for statistical modelling on imputed datasets as well as complete-case datasets.
Patients using snus were younger (mean (SD) age 61.0 (±10.2) years) than patients not using snus (67.6 (±11.1), p<0.001) and more often male (95.4% vs 67.4%, p<0.001). After multivariable adjustment, snus use was not associated with the primary composite outcome of all-cause mortality, new coronary revascularisation or new hospitalisation for heart failure at 1 year (HR 0.98, 95% CI 0.91 to 1.05). In patients using snus at baseline who underwent a second PCI (n=1443), the duration from the index intervention was shorter for subjects who continued using snus (n=921, 63.8%) compared with subjects who had stopped (mean number of days 285 vs 406, p value=0.001).
Snus use at admission for a first PCI was not associated with a higher occurrence of all-cause mortality, new revascularisation or heart failure hospitalisation. Discontinuing snus after a first PCI was associated with a significantly longer duration to a subsequent PCI.
评估使用无烟烟草、鼻烟的患者在首次经皮冠状动脉介入治疗 (PCI) 后未来死亡和心脏事件的风险，与入院时未使用鼻烟的患者进行比较。
瑞典冠状动脉血管造影和血管成形术登记处是一项关于冠状动脉诊断程序和干预的前瞻性登记处。在 2009 年至 2018 年间，共纳入了 74958 名首次接受 PCI 的患者，其中 6790 名使用鼻烟者和 68168 名未使用鼻烟者。我们使用 Cox 比例风险回归模型对基于 imputed 数据集和完整病例数据集进行统计建模。
使用鼻烟的患者比未使用鼻烟的患者年龄更小（平均年龄 (SD) 61.0 (±10.2) 岁比 67.6 (±11.1) 岁，p<0.001），且更常为男性（95.4%比 67.4%，p<0.001）。经过多变量调整后，鼻烟的使用与 1 年时的全因死亡率、新冠状动脉血运重建或因心力衰竭再次住院的主要复合结局无相关性（HR 0.98，95%CI 0.91 至 1.05）。在基线时使用鼻烟且接受第二次 PCI 的患者中（n=1443），继续使用鼻烟的患者（n=921，63.8%）与停止使用鼻烟的患者（n=522，36.2%）相比，从索引干预开始的时间更短（平均天数 285 比 406，p 值=0.001）。
首次 PCI 入院时使用鼻烟与全因死亡率、新血运重建或心力衰竭住院率的增加无关。首次 PCI 后停止使用鼻烟与随后 PCI 的时间明显延长有关。
