Department of Occupational and Environmental Medicine, College of Medicine Dong-A University, Busan, Korea.
Department of Preventive Medicine, College of Medicine Dong-A University, Busan, Korea.
PLoS One. 2021 Apr 2;16(4):e0248386. doi: 10.1371/journal.pone.0248386. eCollection 2021.
The interaction between smoking and the use of antiplatelet agents on the prognosis of vasospastic angina (VA) is rarely investigated.
VA-Korea is a nation-wide multi-center registry with prospective design (n = 1812). The primary endpoint was the composite occurrence of acute coronary syndrome (ACS), symptomatic arrhythmia, and cardiac death. Log-rank test and Cox proportional hazard model were for statistical analysis. Also, we conducted interaction analysis in both additive and multiplicative scales between smoking and antiplatelet agents among VA patients. For additive scale interaction, relative excess risk due to interaction (RERI) was calculated and for multiplicative scale interaction, the ratio of hazard ratio (HR) was calculated. All statistical analysis conducted by Stata Ver 16.1.
Patients who were smoking and using antiplatelet agents had the highest incidence rate in the primary composite outcome. The incidence rate was 3.49 per 1,000 person-month (95% CI: 2.30-5.30, log-rank test for primary outcome p = 0.017) and HR of smoking and using antiplatelet agents was 1.66 (95%CI: 0.98-2.81). The adjusted RERI of smoking and using antiplatelet agents was 1.10 (p = 0.009), and the adjusted ratio of HR of smoking and using antiplatelet agents was 3.32 (p = 0.019). The current study observed the interaction between smoking and using antiplatelet agents in both additive and multiplicative scales.
Smoking was associated with higher rates of unfavorable clinical outcomes among VA patients taking antiplatelet agents. This suggested that VA patients, especially those using antiplatelet agents should quit smoking.
吸烟与抗血小板药物对血管痉挛性心绞痛（VA）预后的相互作用很少被研究。
VA-Korea 是一项全国多中心、前瞻性设计的注册研究（n=1812）。主要终点是急性冠脉综合征（ACS）、有症状心律失常和心脏死亡的复合发生。采用对数秩检验和 Cox 比例风险模型进行统计分析。此外，我们还在 VA 患者中对吸烟和抗血小板药物之间进行了加性和乘法尺度的交互作用分析。对于加性尺度的交互作用，计算了交互归因的超额相对风险（RERI），对于乘法尺度的交互作用，计算了危险比（HR）的比值。所有统计分析均采用 Stata Ver 16.1 进行。
同时吸烟和使用抗血小板药物的患者主要复合结局的发生率最高。发生率为 3.49/1000人月（95%CI：2.30-5.30，log-rank 检验 p=0.017），吸烟和使用抗血小板药物的 HR 为 1.66（95%CI：0.98-2.81）。吸烟和使用抗血小板药物的调整 RERI 为 1.10（p=0.009），调整后的 HR 比值为 3.32（p=0.019）。本研究在加性和乘法尺度上均观察到了吸烟和使用抗血小板药物之间的相互作用。
吸烟与 VA 患者使用抗血小板药物后不良临床结局的发生率增加有关。这表明 VA 患者，尤其是使用抗血小板药物的患者应戒烟。
