经皮冠状动脉介入治疗急性冠脉综合征患者戒烟后残余心血管疾病的风险评估

Residual cardiovascular risk after smoking cessation in patients with acute coronary syndrome undergoing percutaneous coronary intervention

目的探讨行经皮冠状动脉介入治疗(PCI)的急性冠脉综合征(ACS)患者戒烟后残余心血管疾病的风险。方法本研究基于中国冠心病患者大型登记注册研究(OPT-CAD),纳入2012年1月至2014年2月入选OPT-CAD研究的ACS且行PCI的患者,依据吸烟状态(从未吸烟、正在吸烟及已戒烟1年以上)分为未吸烟、吸烟及戒烟3组,比较3组临床资料及介入手术特征、5年临床随访主要心脑血管不良事件(MACCE)的发生情况。所有的数据分析均基于R语言4.1.2版本,通过Trimatch包进行3组倾向性评分匹配。根据数据类型,组间比较分别采用t检验、Wilcoxon检验及χ^(2)检验。采用Kaplan-Meier方法绘制累计事件发生曲线并通过log-rank检验进行组间比较。结果进行倾向性评分匹配后3组患者基线特征基本一致。倾向性评分匹配前,3组1、5年MACCE发生率比较,差异均无统计学意义。倾向性评分匹配后,3组患者1年MACCE发生率差异无统计学意义;吸烟组、戒烟组及未吸烟组患者1年靶血管血运重建率比较,差异有统计学意义[28(3.7%)和24(3.2%)和12(1.6%),P<0.05],且吸烟组和戒烟组均显著高于未吸烟组(P<0.05)。未吸烟组、吸烟组及戒烟组患者5年MACCE发生率、全因死亡率及靶血管血运重建率比较,差异均有统计学意义[94(12.6%)和137(18.3%)和105(14.0%),48(6.4%)和85(11.4%)和59(7.9%),31(4.1%)和58(7.7%)和40(5.3%);均P<0.01];吸烟组5年MACCE发生率、全因死亡率和靶血管血运重建率均高于未吸烟组(均P<0.05)。不同吸烟状态的3组患者5年内的MACCE发生情况及靶血管血运重建的风险随时间变化呈现不同趋势(log-rank P<0.01)。相较于未吸烟组,吸烟组(HR=1.51,95%CI 1.16~1.96;P<0.05)和戒烟组患者(HR=1.14,95%CI 0.87~1.50;P>0.05)5年MACCE发生风险均较高;5年靶血管血运重建的风险,吸烟组(HR=1.96,95%CI 1.26~3.02;P<0.05)和戒烟组(HR=1.33,95%CI 0.83~2.12;P>0.05)均高于未吸烟组。结论吸烟与心血管疾病的复发风险明显相关,戒烟可降低MACCE的发生,但残余风险依然存在。

Objective To investigate the residual cardiovascular disease risk after smoking cessation in patients with acute coronary syndrome(ACS)undergoing percutaneous coronary intervention(PCI).Methods The study was based on a large registry study Optimal Anti-platelet Therapy for Chinese patients with Coronary Artery Disease(OPT-CAD).ACS patients undergoing PCI in the OPT-CAD study from January 2012 to February 2014 were enrolled in the current study and were divided into three groups according to their smoking status(never,current smoking and smoking cessation for more than 1 year):non-smoker,smoker,and former smoker.The three groups were compared in the clinical data and characterizes of the interventional surgery,and the incidence of major adverse cardiovascular and cerebrovascular events(MACCE)in the five-year clinical follow-up visit.All data analysis was based on R language version 4.1.2,and 3 groups of propensity score matching were performed by the Trimatch package.Data comparison between two groups was perfomed using t test,Wilcoxon test or χ^(2)test depending on data type.Cumulative event occurrence curves were drawn using the Kaplan-Meier method and compared between two groups by the log-rank test.Results The baseline characteristics of the three groups were essentially identical after propensity score matching.There was no significant difference in the incidence of 1-and 5-year MACCE between the three groups before the propensity score matching.After the propensity score matching,there was no significant difference in the incidence of 1-year MACCE among the three groups,but incidence of 1-year target vessel revascularization differed significantly among the smoker group,the former smoker group and the non-smoker group[28(3.7%)vs 24(3.2%)vs 12(1.6%),P<0.05],and the rate in the smoker group and former smoker group were higher than the non-smoker group.There were significant differences among the non-smoker group,the smoker group and the former smoker group in the incidence of 5-year MACCE,all-cause mortality,and target vessel revascularization[94(12.6%)vs 137(18.3%)vs 105(14.0%),48(6.4%)vs 85(11.4%)vs 59(7.9%),31(4.1%)vs 58(7.7%)vs 40(5.3%);all P<0.01].The incidence of 5-year MACCE,all-cause mortality and target vessel revascularization in the smoker group were higher than those in the non-smoker group(all P<0.05).The incidence of 5-year MACCE and 5-year target vascular revascularization in the three groups with different smoking status tended to differ over time(log-rank P<0.01).The risk of 5-year MACCE in the smoker group(HR=1.51,95%CI 1.16-1.96;P<0.05)and the former smoker group(HR=1.14,95%CI 0.87-1.50;P>0.05)were higher than that in the non-smoker group.The risk of 5-year target vascular revascularization in the smoker group(HR=1.96,95%CI 1.26-3.02;P<0.05)and the former smoker group(HR=1.33,95%CI 0.83-2.12;P>0.05)were higher than that in the non-smoker group.Conclusion Smoking is significantly associated with the risk of recurrence in cardiovascular disease.Smoking cessation reduces the incidence of MACCE events,but residual cardiovascular risk remains.