吸烟和戒烟对冠状动脉旁路移植术后远期结果的影响

Impact of smoking and smoking cession on long-term outcome of patients after coronary artery bypass grafting

目的探讨吸烟和戒烟对冠状动脉旁路移植术（CABG）后远期结果的影响。方法随访2004年1月1日至2005年12月30日在阜外心血管病医院行CABG的患者2541例。根据术前有无吸烟史，将患者分为不吸烟组和吸烟组，吸烟组又进一步分为术前戒烟亚组，术后戒烟亚组，持续吸烟亚组。观察患者的死亡、主要不良心脑血管事件以及心绞痛的发生情况。采用Cox回归模型分析各组患者发生不良事件的风险。结果随访4．27～6．41年（平均随访5．09年）。CABG术后持续吸烟患者的比例为22．1％。Cox多因素回归分析显示：与不吸烟组比较，吸烟组肿瘤原因死亡（RR：2．38，95％CI：1．06～5．36）、主要不良心脑血管事件（RR：1．26，95％CI：1．01～1．57）和心绞痛（艘：1．29，95％CI：1．04～1．59）的发生风险较高；与不吸烟组比较，持续吸烟亚组全因死亡（RR：2．60，95％CI：1．53～4．46）、心因死亡（RR：2．51，95％CI：1．32—4．78）、肿瘤原因死亡（RR：5．12，95％CI：2．08—12．59）、主要不良心脑血管事件（RR：1．83，95％CI：1．42—2．34）和心绞痛（RR：1．69，95％CI：1．33～2．16）的发生风险较高；术前戒烟亚组和术后戒烟亚组的死亡、主要不良心脑血管事件和心绞痛的发生风险与不吸烟组相似（均P〉0．05）。结论CABG术后患者持续吸烟比例较高。CABG术后持续吸烟会增加死亡率，主要不良心脑血管事件和心绞痛发生率，戒烟可减少不良事件的发生。

Objective To determine the impact of smoking behaviors on long-term outcomes of coronary artery bypass grafting （CABG）. Methods We conducted this survey in 2541 consecutive patients who underwent CABG in Fu Wai hospital from January 1, 2004 to December 30, 2005. The preoperative and postoperative smoking habits were obtained. The patients were divided into never smokers and ever smokers. The ever smokers were further divided into the current smokers who smoked before and after CABG and former smokers who stopped smoking before CABG, quitters who stopped smoking after CABG. Death, major adverse cardiovascular or cerebrovascular events and angina pectoris were observed. The relative risk of adverse events in different patients were analyzed by univariate and multivariate Cox analysis. Resets The patients were followed up for 4. 27 to 6.41 years（average 5.09 years）. After CABG, the percentage of persistent smoking patients was 22. 1% . After adjusting baseline characteristics, relative risk for tumor related death （R.R： 2. 38,95% CI： 1.06 -5.36 ）, major adverse cardiovascular or cerebrovascular events （RR：l.26, 95% CI： 1.01 - 1.57） and angina peetoris （RR： 1.29, 95% CI： 1.04 - 1.59） were significantly higher in ever smokers than in never smokers. Similarly, relative risk of death from all causes （RR：2. 60, 95% CI：I. 53 -4. 46）, cardiac death （RR：2. 51, 95% CI：I. 32 -4. 78） ,tumor cause death （RR：5.12, 95% CI：2. 08 -12. 59）, major adverse cardiovascular or cerebrovascular events （RR： 1.83, 95% CI： 1.42 - 2. 34） and angina peetoris （RR： 1.69, 95% C1：1.33 - 2. 16） were also significantly higher in current smokers than in never smokers. Outcome was similar between patients who stopped smoking and never smokers （ all P 〉 0. 05）. Conclusions Smoking prevalence is still high in patients after CABG in China. Persistent smoking is associated with higher rates of mortality and morbidity after CABG while smoking cession is associated with reduction of morbidity and mortality in patients after CABG.