Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,
China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,
Cerebrovasc Dis. 2024;53(2):144-151. doi: 10.1159/000531349. Epub 2023 Jul 3.
The aim of this study was to investigate the impact of smoking on dual antiplatelet therapy in patients with minor stroke or transient ischemic attack (TIA) under different glycated albumin (GA) levels.
We analyzed data from the Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial. A subgroup of 3,044 patients with baseline GA levels was included and categorized by smoking status and GA levels. The primary efficacy outcome was a new stroke within 90 days. The safety outcome was any bleeding event at 90 days. The interaction of smoking status with antiplatelet therapy was calculated by Cox proportional hazards regression model.
In patients with GA levels ≤15.5%, the proportion of smokers was 37.7% (719/1,908), while in patients with GA levels >15.5%, it was 51.6% (586/1,136). During the 3-month follow-up period, 299 (9.9%) patients had a new stroke occurrence. In patients with elevated GA levels, both smokers and nonsmokers could not benefit from dual antiplatelet therapy (smokers, adjusted hazard ratio [HR] 0.70, 95% confidence interval [CI]: 0.42-1.17; nonsmokers, adjusted HR 0.82, 95% CI: 0.57-1.18). In patients with normal GA levels, dual antiplatelet therapy reduced the risk of stroke recurrence in smokers by 72% (adjusted HR 0.28, 95% CI: 0.14-0.56) and in nonsmokers by 53% (adjusted HR 0.47, 95% CI: 0.26-0.86). However, whether the GA level was elevated or normal, there was no significant interaction between smoking status and antiplatelet therapy.
Smokers with elevated GA levels could not benefit from dual antiplatelet therapy after minor stroke or TIA.
本研究旨在探讨不同糖化白蛋白（GA）水平下，吸烟对小卒中或短暂性脑缺血发作（TIA）患者双联抗血小板治疗的影响。
我们分析了氯吡格雷在急性非致残性脑血管事件高危患者（CHANCE）试验中的数据。纳入了基线 GA 水平的 3044 例患者亚组，并根据吸烟状态和 GA 水平进行分类。主要疗效终点是 90 天内新发卒中。安全性终点是 90 天内任何出血事件。通过 Cox 比例风险回归模型计算吸烟状态与抗血小板治疗的交互作用。
在 GA 水平≤15.5%的患者中，吸烟者比例为 37.7%（719/1908），而在 GA 水平>15.5%的患者中，这一比例为 51.6%（586/1136）。在 3 个月的随访期间，299（9.9%）例患者发生新的卒中。在 GA 水平升高的患者中，吸烟者和不吸烟者均不能从双联抗血小板治疗中获益（吸烟者，调整后的危险比[HR]0.70，95%置信区间[CI]：0.42-1.17；不吸烟者，调整后的 HR 0.82，95% CI：0.57-1.18）。在 GA 水平正常的患者中，双联抗血小板治疗可使吸烟者卒中复发风险降低 72%（调整后的 HR 0.28，95% CI：0.14-0.56），不吸烟者降低 53%（调整后的 HR 0.47，95% CI：0.26-0.86）。然而，无论 GA 水平升高还是正常，吸烟状态和抗血小板治疗之间均无显著交互作用。
GA 水平升高的小卒中或 TIA 后吸烟者不能从双联抗血小板治疗中获益。
