Baig Mirza Faris Ali, Chaliki Kalyan
Asante Three Rivers Medical Center, 500 SW Ramsey Avenue, Grants Pass, OR, USA, 97527.
University of Arizona. 1200 E University Blvd, Tucson, AZ, USA, 85721.
Int J Cardiol Cardiovasc Risk Prev. 2024 May 23;21:200289. doi: 10.1016/j.ijcrp.2024.200289. eCollection 2024 Jun.
Third-degree atrioventricular (AV) blocks are rare but cause significant symptoms and require immediate intervention. Coronary artery disease (CAD) is felt to be the most common etiology. Although smoking is a prominent risk factor for CAD, there is a paucity of data assessing the direct effect of smoking on third-degree AV block.
We performed a retrospective cohort study on adult-weighted admissions in 2019-2020 with a primary diagnosis of third-degree AV block and a history of smoking using the National Inpatient Sample (NIS) database. In-hospital mortality, rates of pacemaker insertion, cardiogenic shock, cardiac arrest, acute kidney injury (AKI), stroke, tracheal intubation, mechanical ventilation, mechanical circulatory support, vasopressor use, length of stay (LOS), and total hospitalization costs were analyzed using regression analysis. We performed a secondary analysis using propensity score matching to confirm the results.
A total of 77,650 admissions met inclusion criteria (33,625 females [43.3 %], 58,315. Caucasians [75 %], 7030 African American [9 %], 6155 Hispanic [7.9 %]; mean [SD] age 75.4.[10.2] years) before propensity matching. A total of 29,380 (37.8 %) patients with AV block were smokers.A total of 5560 patients with and without a history of smoking were matched for the analysis. Smokers had.decreased odds of mortality (aOR, 0.59; CI, 0.44-0.78; p < 0.001), cardiogenic shock, cardiac arrest, tracheal intubation, mechanical ventilation, shorter LOS, and lower total hospital costs in both the multivariable regression and propensity-matched analyses.
Third-degree AV block had lower in-hospital mortality, cardiogenic shock, cardiac arrest, LOS, and total hospitalization cost in patients with smoking history.
三度房室传导阻滞较为罕见，但会引发严重症状，需要立即干预。冠状动脉疾病（CAD）被认为是最常见的病因。尽管吸烟是CAD的一个显著危险因素，但评估吸烟对三度房室传导阻滞直接影响的数据却很匮乏。
我们使用国家住院样本（NIS）数据库，对2019 - 2020年成年加权入院患者进行了一项回顾性队列研究，这些患者的主要诊断为三度房室传导阻滞且有吸烟史。使用回归分析对住院死亡率、起搏器植入率、心源性休克、心脏骤停、急性肾损伤（AKI）、中风、气管插管、机械通气、机械循环支持、血管升压药使用、住院时间（LOS）和总住院费用进行了分析。我们使用倾向得分匹配进行了二次分析以确认结果。
在倾向匹配前，共有77650例入院患者符合纳入标准（33625例女性[43.3%]，58315例白种人[75%]，7030例非裔美国人[9%]，6155例西班牙裔[7.9%]；平均[标准差]年龄75.4[10.2]岁）。共有29380例（37.8%）房室传导阻滞患者为吸烟者。总共对5560例有和没有吸烟史的患者进行了匹配分析。在多变量回归和倾向匹配分析中，吸烟者的死亡几率（调整后比值比，0.59；可信区间，0.44 - 0.78；p < 0.001）、心源性休克、心脏骤停、气管插管、机械通气几率降低，住院时间缩短，总住院费用降低。
有吸烟史的患者发生三度房室传导阻滞时，其住院死亡率、心源性休克、心脏骤停、住院时间和总住院费用较低。
