Cardiovascular Center, Uijeongbu Eulji Medical Center, Uijeongbu-si, Gyeonggi-do, Republic of Korea.
Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea.
Eur Heart J. 2023 Nov 7;44(42):4461-4472. doi: 10.1093/eurheartj/ehad616.
The authors investigated the impact of smoking and its cessation after percutaneous coronary intervention (PCI) on cardiovascular outcomes.
Using a nationwide database from the Korean National Health Insurance System, 74 471 patients undergoing PCI between 2009 and 2016 were classified as non-, ex-, or current smokers, depending on smoking status at the first health check-up within 1 year after PCI. The primary outcome was major adverse cardiovascular and cerebrovascular event (MACCE), a composite of all-cause death, myocardial infarction, coronary revascularization, and stroke.
During 4.0 years of follow-up, current smokers had a 19.8% higher rate of MACCE than non-smokers [adjusted hazard ratio (aHR) 1.198; 95% confidence interval (CI) 1.137-1.263], and ex-smokers tended to have a comparable rate with that of non-smokers (aHR 1.036; 95% CI .992-1.081). For 31 887 patients with both pre- and post-PCI health check-up data, the effects of smoking cessation were analysed. Among quitters who stopped smoking after PCI, quitters with cumulative smoking exposure of <20 pack-years (PYs) tended to have a comparable rate of MACCE with that of persistent non-smokers. However, the rate in quitters with cumulative exposure of ≥20 PYs was comparable with that of persistent smokers [aHR (95% CI) for <10 PY, 1.182 (.971-1.438); 10-20 PYs 1.114 (.963-1.290); 20-30 PYs 1.206 (1.054-1.380); ≥ 30 PYs 1.227 (1.113-1.352); persistent smokers 1.223 (1.126-1.328), compared with persistent non-smokers, respectively, P for interaction <.001].
Smoking is associated with a higher risk of adverse outcomes in patients undergoing PCI. Quitters after PCI with <20 PYs were associated with a risk comparable with that of non-smokers.
本研究旨在探讨经皮冠状动脉介入治疗（PCI）后吸烟及其戒烟对心血管结局的影响。
利用韩国国家健康保险系统的全国性数据库，根据 PCI 后 1 年内首次健康检查时的吸烟状态，将 74471 例患者分为非吸烟者、前吸烟者或现吸烟者。主要终点为全因死亡、心肌梗死、冠状动脉血运重建和卒中的复合终点——主要不良心血管和脑血管事件（MACCE）。
在 4.0 年的随访期间，与不吸烟者相比，现吸烟者的 MACCE 发生率高出 19.8%[校正后危险比（aHR）为 1.198；95%置信区间（CI）为 1.137-1.263]，而前吸烟者的发生率与不吸烟者相近（aHR 为 1.036；95% CI 为 0.992-1.081）。对 31887 例具有 PCI 前后健康检查数据的患者进行了吸烟戒断效果分析。在 PCI 后戒烟的患者中，累积吸烟量<20 包年（PYs）的戒烟者 MACCE 发生率与持续不吸烟者相近。然而，累积暴露量≥20 PYs 的戒烟者的发生率与持续吸烟者相近[aHR（95%CI）：<10 PYs 为 1.182（0.971-1.438）；10-20 PYs 为 1.114（0.963-1.290）；20-30 PYs 为 1.206（1.054-1.380）；≥30 PYs 为 1.227（1.113-1.352）；持续吸烟者为 1.223（1.126-1.328），与持续不吸烟者相比，P 值<0.001，交互作用 P 值<.001]。
吸烟与 PCI 患者不良结局风险增加相关。PCI 后戒烟且累积吸烟量<20 PYs 的患者，其风险与不吸烟者相近。
