Wu Han-Ping, Jan Sheng-Ling, Chang Shih-Lin, Huang Chia-Chen, Lin Mao-Jen
Department of Pediatric Emergency Medicine, China Medical University Children's Hospital, China Medical University, Taichung, Taiwan.
Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
Front Cardiovasc Med. 2022 Feb 11;9:803650. doi: 10.3389/fcvm.2022.803650. eCollection 2022.
The effect of smoking on short-term outcomes among patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) is controversial. However, little is known about the impact of smoking on long-term outcomes in patients with stable coronary artery disease (CAD) who receive PCI.
A total of 2,044 patients with stable CAD undergoing PCI were evaluated. They were divided into two groups according to smoking status (current smokers vs. non-smokers). Baseline characteristics, exposed risk factors, angiographic findings, and interventional strategies were assessed to compare the long-term clinical outcomes between groups. Predictors for myocardial infarction (MI), all-cause death, cardiovascular (CV) death, and repeated PCI procedures were also analyzed.
Compared with non-smokers, current smokers were younger and mostly male (both < 0.01). They also had a lower prevalence of chronic kidney disease (CKD) and diabetes (both < 0.01). Drugs including a P2Y12 receptor inhibitor of platelets (P2Y12 inhibitor), beta-blockers (BB), and statins were used more frequently in current smokers ( < 0.01, < 0.01, = 0.04, respectively). Freedom from all-cause death and CV death was lower in the non-smoker group ( < 0.001, = 0.003, respectively). After adjustment, logistic regression revealed smoking was a major predictor for all-cause death and repeated PCI procedure [hazard ratio(HR): 1.71 and 1.46, respectively].
Smoker's paradox extends to long-term outcome in patients with stable CAD undergoing PCI, which is partially explained by differences in baseline characteristics. However, smoking strongly predicted all-cause mortality and repeated PCI procedures in patients with stable CAD undergoing PCI.
吸烟对接受经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）患者短期预后的影响存在争议。然而，对于接受PCI的稳定型冠状动脉疾病（CAD）患者，吸烟对其长期预后的影响却知之甚少。
共评估了2044例接受PCI的稳定型CAD患者。根据吸烟状况（当前吸烟者与非吸烟者）将他们分为两组。评估基线特征、暴露的危险因素、血管造影结果和介入策略，以比较两组之间的长期临床结局。还分析了心肌梗死（MI）、全因死亡、心血管（CV）死亡和重复PCI手术的预测因素。
与非吸烟者相比，当前吸烟者更年轻，且大多为男性（均P<0.01）。他们患慢性肾脏病（CKD）和糖尿病的患病率也较低（均P<0.01）。当前吸烟者更频繁地使用包括血小板P2Y12受体抑制剂（P2Y12抑制剂）、β受体阻滞剂（BB）和他汀类药物在内的药物（分别为P<0.01、P<0.01、P = 0.04）。非吸烟者组的全因死亡和CV死亡的无事件生存率较低（分别为P<0.001、P = 0.003）。调整后，逻辑回归显示吸烟是全因死亡和重复PCI手术的主要预测因素[风险比（HR）分别为1.71和1.46]。
吸烟者悖论在接受PCI的稳定型CAD患者的长期预后中也存在，这部分可由基线特征的差异来解释。然而，吸烟强烈预测接受PCI的稳定型CAD患者的全因死亡率和重复PCI手术。
