EVALUATION OF PARADOXIC BENEFICIAL-EFFECTS OF SMOKING IN PATIENTS RECEIVING THROMBOLYTIC THERAPY FOR ACUTE MYOCARDIAL-INFARCTION - MECHANISM OF THE SMOKERS PARADOX FROM THE GUSTO-I TRIAL, WITH ANGIOGRAPHIC INSIGHTS
EVALUATION OF PARADOXIC BENEFICIAL-EFFECTS OF SMOKING IN PATIENTS RECEIVING THROMBOLYTIC THERAPY FOR ACUTE MYOCARDIAL-INFARCTION - MECHANISM OF THE SMOKERS PARADOX FROM THE GUSTO-I TRIAL, WITH ANGIOGRAPHIC INSIGHTS
复制标题
DOI：
10.1016/0735-1097(95)00299-5
复制
发表时间：
1995-11-01
影响因子：
24
通讯作者：
ROSS, AM
中科院分区：
文献类型：
--
作者：
BARBASH, GI;REINER, J;ROSS, AM
目标.本研究的目的是评估吸烟与本底的关系。在患有心肌梗死的吸烟者中观察到一种矛盾的有益效果。我们分析了一项急性心肌梗死溶栓治疗多国试验中11，975名非吸烟者、11，117名戒烟者和17，507名吸烟者的结局和基线特征。患者被随机分配到四种溶栓方案中的一种，2,431例患者的血管造影子研究评估了再灌注、再闭塞和心室功能。在调整年龄和性别后，通过logistic回归分析评估吸烟的影响。死亡率模型评估了基线特征对吸烟预后重要性的同时影响。这些过程均使用主试验和血管造影子研究的数据进行;然后将血管造影因素（冠状动脉解剖结构、通畅率和射血分数）添加到模型中。吸烟者的平均年龄为11岁，与非吸烟者相比，吸烟者的合并症或严重冠状动脉疾病较少。非吸烟者的住院和30天死亡率（分别为9.9%和10.3%）显著高于吸烟者（分别为3.7%和4%，均p < 0.001），住院并发症较多。非吸烟者30天死亡率的未校正比值比为3.36（95%可信区间[CI] 2.08 ~ 5.41），校正年龄和性别后为1.21（95% CI 0.71 ~ 2.08），校正所有临床基线特征后为1.08（95% CI 0.59 ~ 1.96）。吸烟者因急性心肌梗死接受溶栓治疗比不吸烟者提前11个档位，这通常是他们预后更好的原因。当评估临床和血管造影基线因素和治疗反应的其他差异时，吸烟者和非吸烟者之间的死亡率无显著差异。
Objectives. Our purpose was to evaluate the relation between smoking and the oBackground. A paradoxic beneficial effect has been observed in smokers with a myocardial infarction. We analyzed outcomes and baseline characteristics of 11,975 nonsmokers, 11,117 es-smokers and 17,507 current smokers in a multinational trial of thrombolysis for acute myocardial infarction.Methods. Patients were randomized to one of four thrombolytic protocols, An angiographic substudy in 2,431 patients evaluated reperfusion, reocclusion and ventricular function. Effects of smoking were evaluated by logistic regression analysis after adjustment for age and gender. A mortality model evaluated the simultaneous effect of baseline characteristics on the prognostic importance of smoking. These processes were performed with data from both the main trial and the angiographic substudy; then angiographic factors (coronary anatomy, patency and ejection fraction) were added to the model.Results. Smokers were significantly younger by a mean of 11 years) and had less comorbidity or severe coronary artery disease than nonsmokers, Nonsmokers had significantly higher hospital and 30-day mortality rates (9.9% and 10.3%, respectively) than smokers (3.7% vs. 4%, respectively, both p < 0.001) and more in hospital complications. The unadjusted odds ratio for 30 day mortality in nonsmokers was 3.36 (95% confidence interval [CI] 2.08 to 5.41), 1.21 (95% CI 0.71 to 2.08) after adjustment for age and gender and 1.08 (95% CI 0.59 to 1.96) after adjustment for all clinical baseline characteristics.Conclusions. Smokers receiving thrombolysis for acute myocardial infarction presented 11 gears earlier than nonsmokers, which generally accounted for their better outcome. When other differences in clinical and angiographic baseline factors and therapeutic responses were evaluated, no significant difference in mortality was seen between smokers and nonsmokers.