The smoker’s paradox after successful fibrinolysis: reduced risk of reocclusion but no improved long-term cardiac outcome
The smoker’s paradox after successful fibrinolysis: reduced risk of reocclusion but no improved long-term cardiac outcome
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成功纤溶后吸烟者的悖论：再闭塞风险降低，但长期心脏结局没有改善
DOI：
10.1007/s11239-008-0238-6
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发表时间：
2009
影响因子：
4
通讯作者：
F. Verheugt
中科院分区：
文献类型：
--
作者：
P. Kievit;M. Brouwer;G. Veen;W. Aengevaeren;F. Verheugt
背景：在接受纤溶治疗st段抬高型心肌梗死（STEMI）的吸烟者中，有一个矛盾的有益的短期结果被报道。这归因于良好的临床和血管造影基线变量以及对纤维蛋白溶解的更好反应。在随访中，梗死动脉再闭塞是一个重要的预后指标。我们研究了吸烟对纤溶成功后再闭塞和长期心脏预后的影响。方法在抗血栓药物预防冠状动脉溶栓再闭塞试验（APRICOT-1和-2）中，499例STEMI患者在纤溶后开通梗死动脉<48小时，随机接受抗血栓治疗，直到3个月的随访血管造影。完成5年临床随访。结果当前吸烟者（317例，64%）具有良好的临床（54岁vs 60岁，P < 0.01）和血管造影（单血管病变61% vs 49%， P = 0.02）基线特征。吸烟者和非吸烟者的再闭塞率分别为21%（67/317）和32% (59/182)（P < 0.01）。5年无梗死心脏生存率无差异：82% vs 85%。再闭塞（HR 2.41, 95%CI 1.05-5.56, P = 0.04）独立预测心脏死亡率。吸烟与降低再闭塞风险独立相关（OR 0.58, 95%CI 0.37-0.91, P = 0.02），但与改善5年心脏预后无关（HR 1.34, 95%CI 0.79-2.25, P = ns）。结论：纤溶成功后，吸烟与再闭塞风险降低40%以上独立相关，这是不良结果的独立预测因子。然而，即使具有更有利的基线特征，吸烟者在低风险人群中也没有改善5年心脏预后。
Background In smokers treated with fibrinolysis for ST-elevation myocardial infarction (STEMI) a paradoxical beneficial short-term outcome has been reported. This was attributed to favorable clinical and angiographic baseline variables and a better response to fibrinolysis. During follow-up infarct artery reocclusion is an important prognosticator. We studied the effects of smoking on reocclusion and long-term cardiac outcome after successful fibrinolysis. Methods In the Antithrombotics in the Prevention of Reocclusion In COronary Thrombolysis trials (APRICOT-1 and -2) 499 STEMI patients with an open infarct artery <48 h after fibrinolysis received randomized antithrombotic treatment until 3-month follow-up angiography. Five-year clinical follow-up was complete. Results Current smokers (317 patients, 64%) had favorable clinical (age 54 vs. 60 years, P < 0.01) and angiographic (single vessel disease 61% vs. 49%, P = 0.02) baseline characteristics. Reocclusion rates were 21% (67/317) in smokers versus 32% (59/182) in non-smokers (P < 0.01). Five-year infarct-free cardiac survival did not differ: 82% vs. 85%. Reocclusion (HR 2.41, 95%CI 1.05–5.56, P = 0.04) independently predicted cardiac mortality. Smoking was independently associated with a reduced risk of reocclusion (OR 0.58, 95%CI 0.37–0.91, P = 0.02), but not with improved 5-year cardiac outcome (HR 1.34, 95%CI 0.79–2.25, P = ns). Conclusions After successful fibrinolysis, smoking is independently associated with a more than 40% reduced risk of reocclusion, which is an independent predictor of adverse outcome. However, even with more favorable baseline characteristics smokers did not have improved 5-year cardiac outcome in this low-risk population.
急性心肌梗死成功再灌注治疗后再闭塞的后果。
影响因子：
37.8
作者：
Ohman,EM;Califf,RM;Topol,EJ;Candela,R;Abbottsmith,C;Ellis,S;Sigmon,KN;Kereiakes,D;George,B;Stack,R
通讯作者：
Stack,R