吸烟状态对左主干病变经皮冠状动脉介入治疗男性患者预后的影响

目的评价吸烟因素对左主干病变接受经皮冠状动脉介入治疗(PCI)男性患者长期预后的影响。方法回顾性分析2004年1月至2015年12月于阜外医院接受左主干病变PCI的男性冠心病患者3122例,其中不吸烟组1207例,当前吸烟组1339例,已戒烟组576例,随访3年,主要研究终点为主要心血管不良事件(major adverse cardiovascular events,MACE)(包括全因死亡、所有心肌梗死以及血运重建的复合终点)及靶病变失败(包括心源性死亡、靶血管相关心肌梗死和靶血管血运重建)。对三组间定量资料采用ANOVA或Cruskal-Wallis检验,对定性资料采用Chi-square检验;生存分析采用Kaplan-Meier分析法和LogRanh检验。基于单因素分析结果进行Cox多因素回归分析。结果当前吸烟组年龄低于不吸烟组及已戒烟组(P<0.0001);预后方面三组患者MACE复合终点(P=0.2772)、靶病变失败(P=0.2522)、支架内血栓(P=0.2118)等主要次要终点方面差异均无统计学意义,各分组中,心源性死亡(P=0.2509)、靶血管血运重建(P=0.9866)、全因死亡(P=0.3130)、所有血运重建(P=0.5028)和卒中(P=0.3985)等事件发生率方面差异无统计学意义;在所有心肌梗死(5.67%比5.10%比2.97%,P=0.0072)和靶血管心肌梗死(5.48%比5.10%比2.89%,P=0.0067)发生率方面,已戒烟组发生率高于不吸烟组,高于当前吸烟组,差异均具有统计学意义。经Cox回归分析,既往心肌梗死(HR=1.339,95%CI 1.042~1.722,P=0.0227)和基线SYNTAX评分(HR=1.0333,95%CI 1.017~1.049,P<0.0001)为MACE的独立危险因素,当前吸烟是靶血管心肌梗死发生的独立保护性因素(HR=0.793,95%CI 0.646~0.974,P=0.0274)。结论对左主干病变行PCI的患者,吸烟状态对其长期MACE或靶病变失败的发生并无影响,而对靶血管相关心肌梗死则是其保护性因素。

Impact of smoking on the prognosis of male patients with left main artery receiving percutaneous coronary intervention

Objective To evaluate the effect of smoking on the long term prognosis of male patients with left main artery lesions who received percutaneous coronary intervention(PCI).Methods A retrospective analysis included 3122 male patients with left main lesions who received PCI in our hospital from Jan.2004 to Dec.2015,was conducted.Patients were divided according to smoking status at admission:1207 in to the non-smoking group,1339 in to the current smoking group and 576 in to the quit smoking group.Follow up was for 3 years.The main study endpoints were major cardiovascular adverse events(MACE)(including endpoints of all-cause death,all myocardial infarctions and revascularization)and target lesion failure(including endpoints of cardiogenic death,target vessel-related myocardial infarction,target vessel-related blood flow reconstruction).ANOVA or Cruskal-Wallis test was applied for quantitative data among the three groups and Chi-square test was applied for qualitative data;Kaplan-Meier analysis and Log Ranh test were used for survival analysis.Cox multivariate regression analysis was performed based on the results of single factor analysis.Results The patients in the current smoking group was younger than that in the non-smoking group and the quit smoking group(P<0.0001).In terms of prognosis,there is no statistical significance in the incidence of composite end point of MACE(P=0.9866),target lesion failure(P=0.2522)and stent thrombosis(P=0.2118),all-cause death(P=0.3130),cardiogenic death(P=0.2509),revascularization(P=0.5028),target vessel related revascularization(P=0.9866)and stroke(P=0.3895),among the three groups.The current smoking group had the lowest incidence rate of myocardial infarction while quit smoking group had the highest incidence rate(5.67%vs.5.10%vs.2.97%,P=0.0072)and so was the incidence of myocardial infarction related to target vessels(5.48%vs.5.10%vs.2.89%,P=0.0067).According to Cox regression analysis,history of myocardial infarction(HR=1.339,95%CI 1.042-1.722,P=0.0227),baseline SYNTAX score(HR=1.0333,95%CI 1.017-1.049,P<0.0001)were the independent risk factors of MACE,while current smoking(HR=0.793,95%CI 0.646-0.974,P=0.0274)proved to be an independent protective factor of target vessel related myocardial infarction.Conclusion For male patients with the left main artery lesions received PCI,smoking has no effect on the long-term MACE or failure of target lesions treatment but current smoking is an independent protective factor for target vessel related myocardial infarction.