Sheikhy Ali, Fallahzadeh Aida, Nayebirad Sepehr, Nalini Mahdi, Sadeghian Saeed, Pashang Mina, Shirzad Mahmoud, Salehi-Omran Abbas, Mansourian Soheil, Bagheri Jamshid, Hosseini Kaveh
Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Front Surg. 2023 Feb 17;10:1047807. doi: 10.3389/fsurg.2023.1047807. eCollection 2023.
The question about the significance of opium consumption as a coronary artery disease (CAD) risk factor still remains open. The present study aimed to evaluate the association between opium consumption and long term outcomes of coronary artery bypass grafting (CABG) in patients without tandard odifiable CAD isk actors (SMuRFs; hypertension, diabetes, dyslipidemia, and smoking).
In this registry-based design, we included 23,688 patients with CAD who underwent isolated CABG between January 2006 to December 2016. Outcomes were compared in two groups; with and without SMuRF. The main outcomes were all-cause mortality, fatal and nonfatal cerebrovascular events (MACCE). Inverse probability weighting (IPW) adjusted Cox's proportional hazards (PH) model was used to evaluate the effect of opium on post-op outcomes.
During 133,593 person-years of follow-up, opium consumption was associated with increased risk of mortality in both patients with and without SMuRFs (weighted Hazard Ratio (HR)s: 1.248 [1.009, 1.574] and 1.410 [1.008, 2.038], respectively). There was no association between opium consumption and fatal and non-fatal MACCE in patients without SMuRF (HR = 1.027 [0.762-1.383], HR 0.700 [0.438-1.118]). Opium consumption was associated with earlier age of CABG in both groups; 2.77 (1.68, 3.85) years in SMuRF-less and 1.70 (1.11, 2.38) years in patients with SMuRFs.
Opium users not only undergo CABG at younger ages but also have a higher rate of mortality regardless of the presence of traditional CAD risk factors. Conversely, the risk of MACCE is only higher in patients with at least one modifiable CAD risk factor.
鸦片消费作为冠状动脉疾病（CAD）危险因素的重要性问题仍未明确。本研究旨在评估在没有标准可改变的CAD危险因素（SMuRFs，即高血压、糖尿病、血脂异常和吸烟）的患者中，鸦片消费与冠状动脉旁路移植术（CABG）长期预后之间的关联。
在这个基于登记处的设计中，我们纳入了2006年1月至2016年12月期间接受单纯CABG的23688例CAD患者。对两组患者的预后进行比较，一组有SMuRFs，另一组没有。主要结局是全因死亡率、致命和非致命性脑血管事件（MACCE）。采用逆概率加权（IPW）调整的Cox比例风险（PH）模型来评估鸦片对术后结局的影响。
在133593人年的随访期间，无论有无SMuRFs，鸦片消费都与死亡率增加相关（加权风险比（HR）分别为：1.248 [1.009, 1.574]和1.410 [1.008, 2.038]）。在没有SMuRF的患者中，鸦片消费与致命和非致命性MACCE之间没有关联（HR = 1.027 [0.762 - 1.383]，HR 0.700 [0.438 - 1.118]）。两组中，鸦片消费都与CABG时年龄较小相关；无SMuRF的患者中为2.77（1.68, 3.85）岁，有SMuRF的患者中为1.70（1.11, 2.38）岁。
鸦片使用者不仅在较年轻时接受CABG，而且无论是否存在传统CAD危险因素，其死亡率都较高。相反，只有至少有一个可改变的CAD危险因素的患者发生MACCE的风险更高。
