Nicotine patch therapy in smoking cessation reduces the extent of exercise-induced myocardial ischemia
Nicotine patch therapy in smoking cessation reduces the extent of exercise-induced myocardial ischemia
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DOI：
10.1016/s0735-1097(97)00128-9
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发表时间：
1997-07-01
影响因子：
24
通讯作者：
Pratt, CM
中科院分区：
文献类型：
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作者：
Mahmarian, JJ;Moye, LA;Pratt, CM
目标.我们试图确定尼古丁贴片疗法用于促进戒烟时对冠心病患者心肌缺血的影响。尼古丁贴片可显著提高吸烟者的戒烟率，但其对心肌缺血患者尝试戒烟的安全性尚不清楚。这是一项前瞻性研究，使用运动铊-201单光子发射计算机断层扫描（SPECT）评估基线时患者吸烟以及14 mg和21 mg尼古丁贴片治疗期间总心肌灌注缺损和缺血性心肌灌注缺损大小的系列变化。入选标准要求患者如果每天吸烟大于或等于1包香烟; 2）具有已知的冠状动脉疾病;和3）具有心肌缺血（即，大于或等于5%的可逆灌注缺损）。所有患者均进行限制性活动平板运动，基线SPECT研究作为其自身对照。我们解释和计算机定量的SPECT图像的测试顺序没有知识。40例入组患者中有36例在基线时和至少14 mg尼古丁贴片治疗期间进行了运动SPECT检查。这些患者的初始灌注缺损大小为17.5 ± 10.6%，平均每天吸烟31 ± 11支，持续40 ± 12年。从基线（17.5 +/- 10.6%）到14 mg（12.6 +/-10.1%）和21 mg（11.8 +/- 9.9%）尼古丁贴片治疗，观察到总灌注缺损尺寸显著降低（p < 0.001）。尽管踏车运动持续时间增加（p < 0.05）和血清尼古丁水平升高（p < 0.001），但仍发生了这种降低。缺损大小的减小与呼出的一氧化碳水平之间存在显著相关性（p < 0.001），因为患者在试验期间减少了74%的吸烟量。尼古丁贴片，当用于促进戒烟，显着减少运动引起的心肌缺血的程度，如运动铊-201 SPECT评估。(C)1997年，美国心脏病学会。
Objectives. We sought to determine the effects of nicotine patch therapy, when used to promote smoking cessation, on myocardial ischemia in patients,vith coronary artery disease.Background. Nicotine patches substantially increase quit rates among cigarette smokers, but their safety in patients with myocardial ischemia who are attempting to quit smoking is unknown.Methods. This is a prospective study using exercise thallium-201 single-photon emission computed tomography (SPECT) to assess serial changes in the total and ischemic myocardial perfusion defect size at baseline while patients were smoking and during treatment with 14- and 21-mg nicotine patches. Entry criteria required that patients If smoked greater than or equal to 1 pack of cigarettes per day; 2) had known coronary artery disease; and 3) had myocardial ischemia (i.e., greater than or equal to 5% reversible perfusion defect) on SPECT. All patients performed symptom-limited treadmill exercise, and the baseline SPECT study served as its own control. We interpreted and computer quantified the SPECT images with no knowledge of the testing sequence.Results. Thirty-six of the 40 enrolled patients had exercise SPECT at baseline and during treatment with at least 14-mg nicotine patches. These patients had an initial perfusion defect size of 17.5 +/- 10.6% while smoking an average of 31 +/- 11 cigarettes per day for 40 +/- 12 years. A significant reduction in the total perfusion defect size (p < 0.001) was observed from baseline (17.5 +/- 10.6%) to treatment with 14-mg (12.6 +/- 10.1%) and 21-mg (11.8 +/- 9.9%) nicotine patches. This reduction occurred despite an increase in treadmill exercise duration (p < 0.05) and higher serum nicotine levels (p < 0.001). There was a significant correlation between the reduction in defect size and exhaled carbon monoxide levels (p < 0.001) because patients reduced their smoking by similar to 74% during the trial.Conclusions. Nicotine patches, when used to promote smoking cessation, significantly reduce the extent of exercise-induced myocardial ischemia as assessed by exercise thallium-201 SPECT. (C) 1997 by the American College of Cardiology.