经皮冠状动脉介入治疗后改用电子烟的预后：一项韩国全国性研究。

Prognosis after switching to electronic cigarettes following percutaneous coronary intervention: a Korean nationwide study.

作者信息

Kang Danbee, Choi Ki Hong, Kim Hyunsoo, Park Hyejeong, Heo Jihye, Park Taek Kyu, Lee Joo Myung, Cho Juhee, Yang Jeong Hoon, Hahn Joo-Yong, Choi Seung-Hyuk, Gwon Hyeon-Cheol, Song Young Bin

机构信息

Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.

出版信息

Eur Heart J. 2025 Jan 3;46(1):84-95. doi: 10.1093/eurheartj/ehae705.

DOI:10.1093/eurheartj/ehae705

PMID:39429032

Abstract

BACKGROUND AND AIMS

Despite the increasing popularity of electronic cigarettes (E-cigarettes), the prognostic impact of switching to E-cigarettes in smokers with coronary artery disease who have undergone percutaneous coronary intervention (PCI) remains unclear.

METHODS

Using a nationwide cohort from the Korean National Health Insurance database, 17 973 adults (≥20 years) identified as smokers (based on a health screening examination within 3 years before PCI) who underwent health screening within 3 years after PCI were enrolled to determine changes in smoking habits. Patients were classified as continued combustible cigarette users, successful quitters, or switchers to E-cigarettes. The group switching to E-cigarettes was further divided into dual users (using both combustible and E-cigarettes) and those exclusively using E-cigarettes. Primary outcomes included major adverse cardiac events (MACEs), a composite of all-cause death, spontaneous myocardial infarction, and repeat revascularization.

RESULTS

Among the total population, 8951 patients (49.8%) continued using combustible cigarettes, 1694 (9.4%) were switched to E-cigarettes, and 7328 (40.7%) successfully quit smoking after PCI. During a median follow-up of 2.4 years, the cumulative incidence of MACE was lower among E-cigarette switchers (10%) or quitters (13.4%) than among continued combustible cigarette users (17%). When continued combustible cigarette users were used as the reference, the multivariable-adjusted hazard ratios with 95% confidence intervals for MACE were 0.82 (0.69-0.98) for switchers to E-cigarettes and 0.87 (0.79-0.96) for successful quitters. Compared with dual users, entirely switching to E-cigarettes was associated with a significantly lower MACE risk (hazard ratio 0.71; 95% confidence interval 0.51-0.99).

CONCLUSIONS

Among smokers who underwent PCI for coronary artery disease, switching to E-cigarette use (particularly complete transition) or quitting smoking was associated with reduced MACE risk than with continued combustible cigarette use.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov NCT06338761.

摘要

背景与目的

尽管电子烟越来越受欢迎，但对于接受经皮冠状动脉介入治疗（PCI）的冠心病吸烟者而言，改用电子烟对预后的影响仍不明确。

方法

利用韩国国民健康保险数据库中的全国性队列，纳入17973名成年人（≥20岁），这些人在PCI前3年内被确定为吸烟者（基于健康筛查检查），并在PCI后3年内接受了健康筛查，以确定吸烟习惯的变化。患者被分为持续使用可燃香烟者、成功戒烟者或改用电子烟者。改用电子烟的组进一步分为双重使用者（同时使用可燃香烟和电子烟）和仅使用电子烟者。主要结局包括主要不良心脏事件（MACE），即全因死亡、自发性心肌梗死和再次血运重建的综合结果。

结果

在总体人群中，8951名患者（49.8%）继续使用可燃香烟，1694名（9.4%）改用电子烟，7328名（40.7%）在PCI后成功戒烟。在中位随访2.4年期间，电子烟改用者（10%）或戒烟者（13.4%）的MACE累积发生率低于持续使用可燃香烟者（17%）。以持续使用可燃香烟者作为对照，改用电子烟者发生MACE的多变量调整风险比及95%置信区间为0.82（0.69 - 0.98），成功戒烟者为0.87（0.79 - 0.96）。与双重使用者相比，完全改用电子烟与显著更低的MACE风险相关（风险比0.71；95%置信区间0.51 - 0.99）。