The Smoker's Paradox: Insights from the Angiographic Substudies of the TIMI Trials
The Smoker's Paradox: Insights from the Angiographic Substudies of the TIMI Trials
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吸烟者悖论：TIMI 试验血管造影子研究的见解
DOI：
10.1023/a:1020470721977
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发表时间：
2002
影响因子：
4
通讯作者：
C. Gibson
中科院分区：
文献类型：
--
作者：
B. Angeja;S. Kermgard;Michael S. Chen;Matthew Mckay;S. Murphy;E. Antman;Christopher P. Cannon;E. Braunwald;C. Gibson
摘要背景：尽管冠心病和急性心肌梗死（AMI）的风险增加，但吸烟者AMI溶栓后的死亡率却比非吸烟者低。我们根据吸烟状况确定了TIMI试验中患者的临床风险特征和冠状动脉血流特征，重点关注微血管血流。
研究方法：在TIMI 4、10A、10 B和TIMI 14试验的2,573例患者中，使用血管造影TIMI血流分级和校正的TIMI帧数（CTFC）测量溶栓后的心外膜血流。采用TIMI心肌灌注分级（TMPG）和TIMI 14时ST段回落百分比测量微血管血流。
结果如下：在临床上，吸烟者的平均年龄（54 vs. 62岁）、糖尿病患病率（11% vs. 16%）和高血压患病率（26% vs. 40%）以及30天死亡率（2.6% vs. 6.2%）均低于非吸烟者（所有p ≤ 0.001）。血管造影显示，单支血管病变（48% vs. 40%）和非左前降支梗死动脉（65.4% vs. 60.8%）在吸烟者中更常见（均p ≤ 0.01）。吸烟者的心外膜TIMI 3级血流比非吸烟者更常见（61% vs. 56%），CTFC更快（34 vs. 37帧/秒，均p ≤ 0.01），尤其是在LAD病变中。然而，吸烟者和非吸烟者之间正常微血管血流（TMPG 3）的频率相似（24% vs. 29%，p = 0.16），ST段完全消退的频率也相似（50% vs. 46%，p = 0.29）。
结论：吸烟者AMI后的死亡率低于非吸烟者，这在很大程度上是由于较低的临床风险和更快的心外膜血流。组织水平灌注的差异似乎并不有助于降低吸烟者的死亡率。
缩写摘要。急性心肌梗死后，主动吸烟者的急性死亡率低于非吸烟者，这似乎在很大程度上可以解释为他们更健康的风险特征，更少的广泛冠状动脉疾病，以及溶栓后更快的心外膜血流。微血管损伤似乎在降低吸烟者死亡风险方面没有发挥主要作用。
AbstractBackground: Despite increased risk for coronary artery disease and acute myocardial infarction (AMI), smokers have a paradoxically lower mortality after thrombolysis for AMI than non-smokers. We determined the clinical risk profiles and coronary flow characteristics of patients in the TIMI trials according to smoking status, focusing on microvascular flow.
Methods: Among 2,573 patients in the TIMI 4, 10A, 10B and TIMI 14 trials, epicardial flow post-thrombolysis was measured using angiographic TIMI flow grades and the corrected TIMI frame count (CTFC). Microvascular flow was measured by TIMI Myocardial Perfusion Grade (TMPG) and, in TIMI 14, the percentage of ST segment resolution.
Results: Clinically, the mean age (54 vs. 62 years), the prevalence of diabetes mellitus (11% vs. 16%) and hypertension (26% vs. 40%), and the 30-day mortality (2.6% vs. 6.2%) were lower among smokers than non-smokers (all p ≤ 0.001). Angiographically, single-vessel disease (48% vs. 40%) and non-left anterior descending infarct arteries (65.4% vs. 60.8%) were more common among smokers (both p ≤ 0.01). Epicardial TIMI grade 3 flow was achieved more often in smokers than non-smokers (61% vs. 56%) and the CTFC was faster (34 vs. 37 frames/sec, both p ≤ 0.01), especially in LAD lesions. However, the frequency of normal microvascular flow (TMPG 3) was similar among smokers and non-smokers (24% vs. 29%, p = 0.16), as was the frequency of complete ST segment resolution (50% vs. 46%, p = 0.29).
Conclusions: Smokers have lower mortality after AMI than non-smokers, due in large part to lower clinical risk profiles and faster epicardial flow. Differences in tissue-level perfusion do not appear to contribute to lower mortality in smokers.
Abbreviated Abstract. After acute MI, active smokers have lower acute mortality than non-smokers that appears to be largely explained by their healthier risk profiles, less extensive coronary disease, and faster epicardial blood flow after thrombolysis. Microvascular injury does not appear to play a major role in the lower mortality risk among smokers.