手术后持续吸食鸦片对手术血运重建长期结局的影响。

Effect of persistent opium consumption after surgery on the long-term outcomes of surgical revascularisation.

机构信息

Department of Cardiology, Tehran University of Medical Sciences, Iran.

Cardiac Primary Prevention Research Center, Tehran University of Medical Sciences, Iran.

出版信息

Eur J Prev Cardiol. 2020 Dec;27(18):1996-2003. doi: 10.1177/2047487320932010. Epub 2020 Jul 16.

DOI:10.1177/2047487320932010

PMID:32673508

Abstract

BACKGROUND

A wrong traditional belief persists among people that opium consumption beneficially affects cardiovascular disease and its risk factors. However, no evidence exists regarding the effect of opium consumption or cessation on the long-term risk of major adverse cardio-cerebrovascular events after coronary artery bypass grafting. We therefore aimed to evaluate the effect of persistent opium consumption after surgery on the long-term outcomes of coronary artery bypass grafting.

METHODS

The study population consisted of 28,691 patients (20,924 men, mean age 60.9 years), who underwent coronary artery bypass grafting between 2007 and 2016 at our centre. The patients were stratified into three groups according to the status of opium consumption: never opium consumers ( = 23,619), persistent postoperative opium consumers ( = 3636) and enduring postoperative opium withdrawal ( = 1436). Study endpoints were 5-year mortality and 5-year major adverse cardio-cerebrovascular events, comprising all-cause mortality, acute coronary syndrome, cerebrovascular accident and revascularisation.

RESULTS

After surgery, 3636 patients continued opium consumption, while 1436 patients persistently avoided opium use. The multivariable survival analysis demonstrated that persistent post-coronary artery bypass grafting opium consumption increased 5-year mortality and 5-year major adverse cardio-cerebrovascular events by 28% (hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.06-1.54; = 0.009) and 25% (HR 1.25, 95% CI 1.13-1.40; < 0.0001), respectively. It also increased the 5-year risk of acute coronary syndrome by 34% (sub-distribution HR 1.34, 95% CI 1.16-1.55; < 0.0001).

CONCLUSIONS

The present data suggest that persistent post-coronary artery bypass grafting opium consumption may significantly increase mortality, major adverse cardio-cerebrovascular events and acute coronary syndrome in the long term. Future studies are needed to confirm our findings.

摘要

背景

人们一直存在一种错误的传统观念，认为吸食鸦片有益于心血管疾病及其危险因素。然而，目前尚无关于吸食鸦片或戒除鸦片对冠状动脉旁路移植术后主要不良心脑血管事件长期风险的影响的证据。因此，我们旨在评估手术后持续吸食鸦片对冠状动脉旁路移植术长期结果的影响。

方法

研究人群包括 2007 年至 2016 年间在我们中心接受冠状动脉旁路移植术的 28691 名患者（20924 名男性，平均年龄 60.9 岁）。根据鸦片消费状况，将患者分为三组：从不吸食鸦片者（=23619 人）、术后持续吸食鸦片者（=3636 人）和术后持续戒断鸦片者（=1436 人）。研究终点为 5 年死亡率和 5 年主要不良心脑血管事件，包括全因死亡率、急性冠状动脉综合征、脑血管意外和血运重建。

结果

手术后，3636 名患者继续吸食鸦片，而 1436 名患者持续避免吸食鸦片。多变量生存分析表明，冠状动脉旁路移植术后持续吸食鸦片可使 5 年死亡率和 5 年主要不良心脑血管事件分别增加 28%（风险比（HR）1.28，95%置信区间（CI）1.06-1.54；=0.009）和 25%（HR 1.25，95%CI 1.13-1.40；<0.0001）。它还使 5 年急性冠状动脉综合征的风险增加了 34%（亚分布 HR 1.34，95%CI 1.16-1.55；<0.0001）。