吸烟对冠心病接受介入治疗患者5年主要心血管不良事件的影响

Effect of smoking on five-year's major adverse cardiovascular events in patients with coronary artery disease undergoing interventional therapy

目的:评估吸烟对接受介入治疗的冠心病患者的远期预后的影响。方法:本研究中入选接受冠脉介入治疗后经劝阻仍然吸烟的冠心病患者290例,同时利用倾向性评分1比1匹配290例不吸烟的冠心病患者作为对照组,通过门诊和电话随访所有研究对象的5年主要心血管事件(MACE)。结果:①两组研究对象的基线资料、冠状动脉狭窄程度、出院用药,总体无差异;②吸烟组的凝血酶原时间缩短、国际标准化比值降低、凝血酶原时间活动度增加、纤维蛋白(原)降解产物增加。③吸烟组的MACE事件明显高于不吸烟组,这一差异在介入治疗20个月逐渐明显,主要表现为吸烟组频发心绞痛相关的再血管化率更高。④按照有无MACE事件分组,MACE事件组的吸烟率较高。结论:接受介入治疗后经劝阻仍然吸烟的冠心病患者,总体预后比不吸烟的患者差,在介入治疗20个月后逐渐明显,表现为心绞痛相关的再血管化率较高,推测吸烟对凝血系统的影响可能是潜在的机制之一。

Objective:To evaluate the effect of smoking on the long-term prognosis of patients with coronary artery disease(CAD)received percutaneous coronary intervention(PCI).Methods:in this study,290 CAD patients who were still smoking after PCI were selected.At the same time,290 non-smoking patients were matched by propensity score method with a ratio of 1:1 as the control group.All subjects were followed up for 5-year’major adverse cardiovascular events(MACE)through outpatient and telephone.Results:①there was no significant difference between the two groups in baseline data,degree of coronary artery stenosis and discharge medication;②In smoking group,prothrombin time and international standardized ratio were shortened,prothrombin time activity was increased,and fibrin degradation product was higher.③MACE in smoking group were significantly higher than those in non-smoking group,and the difference was gradually obvious after 20 months of PCI;The main MACE in smoking group was the higher revascularization rate caused by frequent angina pectoris.④All subjects were divided into two groups according to the presence or absence of MACE.The smoking rate in MACE group were significantly higher.Conclusions:The overall prognosis of patients who still smoke after PCI is worse than that of non-smoking patients,which is mainly reflected in the revascularization for recurrent angina pectoris.This difference is gradually obvious 20 months after PCI.It is speculated that the effect of smoking on coagulation system might be one of the potential mechanisms.