Impact of Smoking Status on Hospital Outcome of Patients with ST-Segment Elevation Myocardial Infarction Either Treated by Pharmaco-Invasive Strategy or Primary Percutaneous Coronary Intervention

Introduction: Smoking is a common public problem with a high health burden. Many studies have shown that there are many hazardous actions of smoking on body systems especially haemostatic, respiratory and circulatory systems. Smoking may increase the thrombus burden in patients with acute coronary syndrome. The “smoker’s paradox” has been described for more than 25 years. Its existence and its effect on patients’ outcome post-myocardial infarction are debatable. Methods: Our prospective observational study was conducted from-August 2018 to August 2019 on STEMI patients with the duration from onset of symptoms to first medical contact were 12 hours or less. We included 199 patients in our study. Patients are divided into 4 groups Group 1 (Smokers treated by PPCI) Group 2 (Non-smokers treated by PPCI) Group 3 (Smoker treated by pharmaco-invasive strategy) Group 4 (Non- smoker treated by pharmaco-invasive strategy) TIMI flow before and after PCI, duration of hospital stay and all caeses of MACE were assessed in each patient. Results: Smokers are younger than non-smokers and have fewer co-mor- bidities. Patients treated by primary PCI and pharmaco-invasive strategy either smokers ornon-smokers showed no significant difference in angiographic data and outcome except that smokers treated by pharmaco-invasive strategy had a lower incidence of TIMI flow III at diagnostic angiography before PCI with P value (0.047). Conclusion: There is no actual smokers paradox. A pharmaco-invasive strategy is a good option when a PPCI is not available. Finally, early transfer of smokers treated with a pharmaco-invasive strategy to a PCI capable hospital for early intervention may be recommended.

吸烟对急性ST段抬高型心肌梗死急性期心肌损伤及预后的影响

目的·结合心脏磁共振技术探讨吸烟对ST段抬高型心肌梗死(ST-segment elevation myocardial infraction,STEMI)患者急性期心肌损伤的影响及长期预后。方法·筛选349名自2012年5月至2017年8月入组的STEMI患者并至少随访2年,随访的主要终点指标包括全因死亡、再发心肌梗死及卒中,次要终点指标为再发心力衰竭入院。根据患者入组前吸烟状态分为吸烟组及非吸烟组,结合是否出现心肌内出血(intramyocardial hemorrhage,IMH)进一步分析2组患者终点事件发生率的差异。结果·吸烟组共221人,占总样本的63.3%;吸烟组患者的平均发病年龄较非吸烟组提前4.66岁,但住院期间左心室血栓发生率及脑利钠肽水平均低于非吸烟组(P=0.023,P=0.000)。在影像学参数中,2组患者的左心室射血分数差异无统计学意义(P>0.05),但吸烟患者的收缩末期及舒张末期容积指数与非吸烟组患者差异有统计学意义(P=0.019,P=0.007)。吸烟与非吸烟患者的主要终点事件发生率差异无统计学意义(P>0.05),吸烟患者的心力衰竭再入院率低于非吸烟患者,但进一步校正基线差异后2组间心力衰竭发生率差异无统计学意义(P=0.167)。在有IMH的患者中,吸烟对主要终点起到保护作用(HR=0.266,P=0.008)。在无IMH的患者中,非吸烟者的全因死亡及再发心肌梗死预后优于吸烟者(P=0.024)。结论·在STEMI患者中吸烟对长期预后无保护作用;在合并IMH时吸烟对全因死亡、再发心肌梗死及卒中具有一定保护作用,但在无IMH的患者中,吸烟患者预后差于非吸烟者。

急性ST段抬高型心肌梗死患者PCI预后影响因素的研究进展

ST段抬高型心肌梗死(STEMI)是常见急性心肌梗死分型,发病率及死亡率高。目前急性期的ST段抬高型心肌梗死的救治原则是在最短的血流灌注时间内迅速恢复冠状动脉的有效血流和灌注,直接进行经皮冠状动脉介入治疗(PCI)为STEMI急性期的首选治疗方案,其能及时地开放与梗死相关的罪犯动脉,有效恢复血流,且创伤较小、患者康复快。然而,STEMI患者在接受直接PCI治疗后,仍有部分患者预后不佳。其中“吸烟者悖论”对STEMI患者预后影响仍有较大争议,而许多研究已经证实远隔缺血处理(RIC)的积极作用。本文主要根据近年来国内外关于公认或仍有争议的STEMI患者行直接PCI的预后影响因素的研究进展做一综述。