Hasdai D, Garratt K N, Grill D E, Mathew V, Lerman A, Gau G T, Holmes D R
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic Rochester, MN 55905, USA.
Mayo Clin Proc. 1998 Mar;73(3):205-9. doi: 10.4065/73.3.205.
To identify factors predictive of smoking cessation after successful percutaneous coronary revascularization.
We undertook a case-control study of the smoking status of all patients at Mayo Clinic Rochester from September 1979 through December 1995 who were smokers at the time of an index percutaneous coronary revascularization procedure in the non-peri-infarction setting (no myocardial infarction within 24 hours). Maximal duration of prospective follow-up was 16 years. Patients were classified into those who permanently quit smoking immediately after the procedure (N = 435; mean follow-up, 5.1 +/- 3.7 years) or those who continued to smoke at some time during follow-up (N = 734; mean follow-up, 5.3 +/- 3.7 years). Logistics regression models were formulated to determine independent predictors of smoking cessation.
Predictors of continued smoking were greater prior cigarette consumption (odds ratio [OR] = 1.009 for each pack-year; 95% confidence interval [CI] = 1.004 to 1.014) and having one or more risk factors for coronary artery disease other than cigarette smoking (OR = 1.49; 95% CI = 1.15 to 1.93). Older age (OR = 0.98 for each additional year; 95% CI = 0.97 to 0.99) and unstable angina at time of initial assessment (OR = 0.69; 95% CI = 0.52 to 0.91) were associated with less likelihood of continued smoking.
Younger patients with a worse risk profile and greater prior cigarette consumption were more likely than other patients to continue smoking after percutaneous coronary revascularization in the non-peri-infarction setting. Patients who had unstable angina were more likely to quit smoking than those who had stable angina. Despite the proven benefits of smoking cessation after percutaneous coronary revascularization, a substantial proportion of smokers (63%) continue to smoke; thus, smoking-cessation counseling should be addressed in this population.
确定成功进行经皮冠状动脉血运重建术后戒烟的预测因素。
我们对1979年9月至1995年12月在梅奥诊所罗切斯特分院接受非梗死期（24小时内无心肌梗死）首次经皮冠状动脉血运重建术时吸烟的所有患者的吸烟状况进行了病例对照研究。前瞻性随访的最长时间为16年。患者被分为术后立即永久戒烟者（N = 435；平均随访时间为5.1±3.7年）或随访期间某个时间继续吸烟者（N = 734；平均随访时间为5.3±3.7年）。构建逻辑回归模型以确定戒烟的独立预测因素。
继续吸烟的预测因素包括既往吸烟量较大（每包年的比值比[OR] = 1.009；95%置信区间[CI] = 1.004至1.014）以及除吸烟外有一个或多个冠状动脉疾病危险因素（OR = 1.49；95%CI = 1.15至1.93）。年龄较大（每增加一岁OR = 0.98；95%CI = 0.97至0.99）和初次评估时不稳定型心绞痛（OR = 0.69；95%CI = 0.52至0.91）与继续吸烟的可能性较小相关。
在非梗死期经皮冠状动脉血运重建术后，风险状况较差且既往吸烟量较大的年轻患者比其他患者更有可能继续吸烟。患有不稳定型心绞痛的患者比患有稳定型心绞痛的患者更有可能戒烟。尽管经皮冠状动脉血运重建术后戒烟已被证实有益，但仍有相当比例的吸烟者（63%）继续吸烟；因此，应对该人群进行戒烟咨询。
