CAJ | 학술논문

目的评估吸烟对急性ST段抬高心肌梗死(ASTEMI)患者临床预后的影响.方法连续选取2009年5月至2010年5月辽宁地区20家医院的ASTEMI患者.将入选患者分为吸烟组和不吸烟组.比较患者的基线特征及住院时的一般状况及随访治疗.观察主要终点心源性死亡及次要终点非致死性心肌梗死、脑卒中、再次血运重建的发生情况.多因素Cox风险回归模型预测独立危险因素.结果 1213例患者成功入选,吸烟组588例,不吸烟组625例.吸烟组中接受紧急PCI治疗的显著多于不吸烟组(40.8％比22.1％,P＜0.001).吸烟组随访药物使用均显著高于不吸烟组(阿司匹林:75.3％比62.2％,P＜0.001；氯吡格雷:40.5％比32.2％,P=0.003;β受体阻滞剂:45.4％比36.0％,P=0.001;血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂:38.3％比32.2％,P=0.026;他汀药:57.3％比44.2％,P＜0.001).吸烟组心源性死亡的发生显著低于不吸烟组(10.2％比24.2％,P＜0.001),次要终点事件两组差异无统计学意义.多因素分析发现吸烟(HR 2.777,95％CI 1.113 ～6.928,P =0.029)、PCI治疗(HR0.208,95％ CI 0.062 ～0.700,P=0.011)、年龄(HR 1.049,95％ CI 1.005～1.095,P=0.028)、阿司匹林(HR 0.165,95％ CI 0.061 ～0.446,P ＜0.001)及他汀药(HR 0.382,95％ CI 0.317 ～0.462,P＜0.001)是影响ASTEMI患者心源性死亡的独立危险因素.结论 ASTEMI的患者中吸烟者心源性死亡的发生率低于不吸烟者,但吸烟仍是ASTEMI患者心源性死亡的独立危险因素.
목적 평고흡연대급성ST단태고심기경사(ASTEMI)환자림상예후적영향.방법 련속선취2009년5월지2010년5월료녕지구20가의원적ASTEMI환자.장입선환자분위흡연조화불흡연조.비교환자적기선특정급주원시적일반상황급수방치료.관찰주요종점심원성사망급차요종점비치사성심기경사、뇌졸중、재차혈운중건적발생정황.다인소Cox풍험회귀모형예측독립위험인소.결과 1213례환자성공입선,흡연조588례,불흡연조625례.흡연조중접수긴급PCI치료적현저다우불흡연조(40.8％비22.1％,P＜0.001).흡연조수방약물사용균현저고우불흡연조(아사필림:75.3％비62.2％,P＜0.001；록필격뢰:40.5％비32.2％,P=0.003;β수체조체제:45.4％비36.0％,P=0.001;혈관긴장소전환매억제제/혈관긴장소수체길항제:38.3％비32.2％,P=0.026;타정약:57.3％비44.2％,P＜0.001).흡연조심원성사망적발생현저저우불흡연조(10.2％비24.2％,P＜0.001),차요종점사건량조차이무통계학의의.다인소분석발현흡연(HR 2.777,95％CI 1.113 ～6.928,P =0.029)、PCI치료(HR0.208,95％ CI 0.062 ～0.700,P=0.011)、년령(HR 1.049,95％ CI 1.005～1.095,P=0.028)、아사필림(HR 0.165,95％ CI 0.061 ～0.446,P ＜0.001)급타정약(HR 0.382,95％ CI 0.317 ～0.462,P＜0.001)시영향ASTEMI환자심원성사망적독립위험인소.결론 ASTEMI적환자중흡연자심원성사망적발생솔저우불흡연자,단흡연잉시ASTEMI환자심원성사망적독립위험인소.
Objective To explore the effects of smoke on the clinical prognosis of patients with acute ST-segment elevation myocardial infarction ( ASTEMI).Methods A total of 1213 consecutive ASTEMI patients were admitted into 20 hospitals in Liaoning province between May 2009 and May 2010.They were stratified into smoke ( n =588 ) and non-smoke ( n =625 ) groups.Basic demographic profiles,treatment data and clinical outcomes were compared between two groups.The primary endpoint was cardiac death and the secondary endpoints included non-fatal myocardial infarction,stroke and revascularization.Cox proportional hazard analyses were performed.Results The proportion of percutaneous coronary intervention (PCI) in the smoke group was significantly higher than that in the non-smoke group (40.8％ vs 22.1％,P ＜0.001 ).During the follow-up period,the medication rate was significantly higher in the smoke group than that in the non-smoke group ( aspirin:75.3％ vs 62.2％,P ＜0.001 ; clopidogrel:40.5％ vs 32.2％,P =0.003 ; β receptor blockade:45.4％ vs 36.0％,P =0.001 ; angiotensin-converting-enzyme inhibitor/angiotensin Ⅱ receptor blocker (ACEI/ARB):38.3％ vs 32.2％,P =0.026; statins:57.3％ vs 44.2％,P ＜0.001 ).During the follow-up period,the rate of cardiac death was lower in the smoke group than that in the non-smoke group ( 10.2％ vs 24.2％,P ＜ 0.001 ).No significant differences existed between two groups.During the follow-up period,the rate of cardiac death was significantly correlated with smoke ( HR 2.777,95％ CI 1.113 - 6.928,P =0.029 ),PCI ( HR 0.208,95％ CI 0.062 - 0.700,P =0.011),age (HR 1.049,95％ CI 1.005 - 1.095,P =0.028),aspirin (HR 0.165,95％ CI0.061 -0.446,P ＜ 0.001 ) and statins ( HR 0.382,95％ CI 0.317 - 0.462,P ＜ 0.001 ).Conclusion Among the ASTEMI patients,the rate of cardiac death is significantly lower in the smoke group than that in the non-smoke group.And it is significantly correlated with such independent risk factors as smoke,PCI,age,aspirin and statins.