吸烟的冠心病患者冠状动脉病变特点及经皮冠状动脉介入治疗后长期预后评价  

Characteristics of Coronary Artery Lesions in Smokers With Coronary Heart Disease and Prognostic Evaluation After Percutaneous Coronary Intervention

作　　者：王娟[1] 许浩博 乔树宾[1] 管常东 胡奉环[1] 杨伟宪[1] 袁建松[1] 郭超[1] 段欣[1] 高润霖[1] 徐波[1] WANG Juan;XU hao-bo;QIAO Shu-bin;GUAN Chang-dong;HU Feng-huan;YANG Wei-xian;YUAN Jian-song;GUO Chao;DUAN Xin;GAO Run-lin;XU Bo(Coronary Heart Disease Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing（100037）,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院冠心病中心,100037

出　　处：《中国循环杂志》2018年第11期1053-1058,共6页Chinese Circulation Journal

摘　　要：目的:评价吸烟的冠心病患者的冠状动脉病变特点及经皮冠状动脉介入治疗(PCI)后的长期预后。方法:本研究人群来自PANDAⅢ临床试验。PANDAⅢ是一项前瞻性、多中心、全人群的随机对照研究,自2013-12至2014-08期间共入选了来自46家中心的2 348例患者,平均年龄(61.2±10.6)岁,男性1 658例(70.6%)。所有受试者均接受PCI,均置入生物可降解聚合物涂层药物洗脱支架。根据入院时吸烟状态将2 348例患者分为非吸烟组(n=1 169),已戒烟组(n=300例)和吸烟组(n=879)。随访2年,主要研究终点为主要不良心血管事件(MACE),定义为全因死亡、心肌梗死和血运重建,次要终点包括支架血栓和靶病变失败(TLF),定义为心原性死亡,靶血管相关心肌梗死和缺血驱动的靶病变血运重建。结果:吸烟组和戒烟组均以男性患者为主,与非吸烟组和已戒烟组相比,吸烟组患者的年龄更小(P<0.0001),合并高血压(P=0.0002)、糖尿病(P=0.0052)、既往PCI史(P<0.0001)比例更低。吸烟组入院诊断急性心肌梗死比例高达41.3%(363/879),较已戒烟组和非吸烟组明显增高(P<0.0001)。非吸烟组、已戒烟组和吸烟组中分别有1 130例(96.7%)、286例(95.3%)和846例(96.2%)患者完成了2年随访。吸烟组、已戒烟组和非吸烟组的MACE发生率分别为11.23%、13.64%和12.21%(P=0.54)。COX多因素分析显示,吸烟不是全因死亡和TLF的独立预测因素(P>0.05)。结论:吸烟的冠心病患者急性心肌梗死发生率高,PCI后,吸烟组、戒烟组和非吸烟组的长期MACE无差异。Objectives： To investigate the characteristics of coronary lesions and evaluate the prognosis post-percutaneous coronary intervention（PCI）in smokers with coronary heart disease. Methods： The data were derived from PANDA III, which was a perspective, multi-center, ＂all-comer＂, randomized controlled trial. Between Dec. 2013 and Aug. 2014, 2 348 patients from 46 centers were enrolled. Mean age was（61.2 ±10.6） years old, 1 658 patients（70.6%） were male. All the patients underwent PCI and biodegradable polymer drug eluting stents were implanted as indicated. Patients were divided into non-smoking group, quitter group and smoking-group based on the basis of smoking status at baseline. Primary endpoint was major adverse cardiac events（MACE）, including all-cause mortality, myocardial infarction and repeated revascularization. Secondary endpoint were stent thrombosis and target lesion failure（TLF）, including cardiac death, target vessel myocardial infarction and ischemia driven target lesion revascularization. Results： Smokers and quitters were more often males. Compared with non-smoking group and quitter group, patients in smoking group were significantly younger（P〈0.0001）, proportion of hypertension（P=0.0002）, diabetes mellitus（P=0.0052） and previous PCI history（P〈0.0001） was significantly lower. The incidence of acute myocardial infarction in the smoking group was as high as 41.3%（363/879）, which was significantly higher than that of the quitter group and non-smoking group（P〈0.0001）. A total of 1 130（96.7%）, 286（95.3%） and 846（96.2%） patients in the non-smoking group, quitter group and smoking-group completed the 2-year follow-up, respectively. The results of 2-years follow-up showed that MACE rate of non-smoking group, quitter group and smoking-group was 11.23%, 13.64% and 12.21%（P=0.54）, respectively. Multivariable cox regression analysis indicated that smoking status was not an independent predictor for all-cause mortality and TLF. Conclusi

关 键 词：吸烟 冠状动脉粥样硬化性心脏病 经皮冠状动脉介入治疗 

分 类 号：R54[医药卫生—心血管疾病]