胸外科手术中的吸烟、秋水仙碱与术后结局：COP-AF随机对照试验的事后分析
Smoking, Colchicine and Postoperative Outcomes in Thoracic Surgery: Post Hoc Analysis of the COP-AF Randomized Controlled Trial.
作者信息
Ofori Sandra, Wang Michael K, Popova Ekaterine, McIntyre William F, Chan Matthew, Sessler Daniel I, Giulia Veronesi, Warwas Mark, Balasubramanian Kumar, Tandon Vikas, Finley Christain, Anna Gonzalez Tallada, Cata Juan, Srinathan Sadeesh, Reimer Cara, McLean Sean, Trujillo Juan Carlos, Fleischmann Edith, Voltolini Luca, Cruz Patricia, Maziak Donna E, Gutiérrez-Soriano Laura, Amir Mohammed, Bossard Matthias, Wang Chew Yin, Devereaux P J, Conen David
机构信息
Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
出版信息
CJC Open. 2025 Apr 21;7(7):860-870. doi: 10.1016/j.cjco.2025.04.008. eCollection 2025 Jul.
BACKGROUND
To determine, among patients who underwent major noncardiac thoracic surgery, the association between smoking and perioperative atrial fibrillation (AF) and myocardial injury after noncardiac surgery (MINS), and whether the effect of colchicine use on these outcomes varied by smoking status.
METHODS
This study is a subgroup analysis of the Colchicine for the Prevention of Perioperative Atrial Fibrillation (COP-AF) randomized clinical trial. A total of 3209 participants who underwent major noncardiac thoracic surgery were randomized to receive colchicine, 0.5 mg twice daily, or identical placebo, for 10 days starting 2-4 hours before surgery. The co-primary outcomes were clinically significant perioperative AF and MINS during the 14-day follow-up.
RESULTS
A total of 687 (21.4%) were current smokers, 1577 (49.1%) were former smokers, and 945 (29.5%) were never smokers. AF occurred in 7.7%, 7.6%, and 5.3%, and MINS occurred in 21.0%, 19.7%, and 17.6% of current, former, and never smokers, respectively. Compared to never smokers, the adjusted hazard ratio for AF was 1.72 (95% confidence interval [CI] 1.07-2.77, = 0.02) in current smokers and 1.46 (95% CI 0.99-2.16, = 0.06) in former smokers, and the adjusted hazard ratio for MINS was 1.16 (95% CI 0.87-1.54, = 0.32) in current smokers and 1.02 (95% CI 0.81-1.28, = 0.88) in former smokers. No interaction occurred between smoking status and colchicine allocation for AF (interaction 0.82) or MINS (interaction , 0.08).
CONCLUSIONS
Current smoking was associated with a small but increased risk of perioperative AF but not MINS after thoracic surgery. The effect of colchicine use on either outcome was not modified by smoking status.
CLINICAL TRIAL REGISTRATION
NCT03310125.
背景
在接受非心脏大手术的患者中，确定吸烟与围手术期心房颤动（AF）以及非心脏手术后心肌损伤（MINS）之间的关联，以及秋水仙碱使用对这些结局的影响是否因吸烟状况而异。
方法
本研究是预防围手术期心房颤动秋水仙碱（COP-AF）随机临床试验的亚组分析。共有3209例接受非心脏大手术的参与者被随机分配，从手术前2至4小时开始，每天两次服用0.5毫克秋水仙碱或相同的安慰剂，持续10天。共同主要结局是14天随访期间具有临床意义的围手术期AF和MINS。
结果
共有687例（21.4%）为当前吸烟者，1577例（49.1%）为既往吸烟者，945例（29.5%）为从不吸烟者。当前吸烟者、既往吸烟者和从不吸烟者中AF的发生率分别为7.7%、7.6%和5.3%，MINS的发生率分别为21.0%、19.7%和17.6%。与从不吸烟者相比，当前吸烟者AF的调整后风险比为1.72（95%置信区间[CI]1.07 - 2.77，P = 0.02），既往吸烟者为1.46（95%CI 0.99 - 2.16，P = 0.06）；当前吸烟者MINS的调整后风险比为1.16（95%CI 0.87 - 1.54，P = 0.32），既往吸烟者为1.02（95%CI 0.81 - 1.28，P = 0.88）。吸烟状况与秋水仙碱分配对AF（交互作用P = 0.82）或MINS（交互作用P = 0.08）均未产生交互作用。
结论
当前吸烟与胸外科手术后围手术期AF风险小幅增加相关，但与MINS无关。吸烟状况未改变秋水仙碱对任何一种结局的影响。
临床试验注册
NCT03310125。
Zotero 插件