Smoking cessation is associated with decreased mortality and improved amputation-free survival among patients with symptomatic peripheral artery disease
Smoking cessation is associated with decreased mortality and improved amputation-free survival among patients with symptomatic peripheral artery disease
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DOI：
10.1016/j.jvs.2014.08.064
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发表时间：
2014-12-01
影响因子：
4.3
通讯作者：
Laird, John R.
中科院分区：
文献类型：
--
作者：
Armstrong, Ehrin J.;Wu, Julie;Laird, John R.
目的：虽然戒烟是建议所有患者外周动脉疾病，有关于吸烟的患病率在血管造影术或戒烟对临床outcome.Methods的影响的患者之间的数据很少：连续性患者跛行或严重肢体缺血谁接受外周血管造影术从2006年至2013年被纳入观察性队列分析。在血管造影时和随访门诊访视期间评估吸烟状况。Kaplan-Meier分析用于评估戒烟、死亡率和无截肢生存率之间的关系。结果：在739例患者（423例男性和316例女性;平均年龄60 ± 12岁）中，204例（28%）在下肢血管造影时仍为活跃吸烟者。在血管造影时，每天吸烟的平均数量为16 +/- 10，平均包年为40 +/- 25。在接下来的一年中，61例患者（30%）成功戒烟并保持持续戒烟。两组之间的基线药物使用没有显著差异。戒烟者与非戒烟者的平均踝臂指数也相似（0.53 +/- 24 vs 0.49 +/- 0.22; P = 0.3）。在5年的随访中，戒烟患者的全因死亡率显著降低（14% vs 31%;风险比，0.40; 95%置信区间，0.18-0.90）和无截肢生存率提高（81%对60%;风险比，0.43，95%置信区间，0.22-0.86）与继续吸烟的患者相比，大部分差异是由戒烟患者的死亡率降低引起的。结论：大约三分之一的患有外周动脉疾病的主动吸烟者成功戒烟
Objective: Although smoking cessation is recommended for all patients with peripheral artery disease, there are little data regarding the prevalence of smoking among patients at the time of angiography or the effect of smoking cessation on clinical outcomes.Methods: Consecutive patients with claudication or critical limb ischemia who underwent peripheral angiography from 2006 to 2013 were included in an observational cohort analysis. Smoking status was assessed at the time of angiography and during follow-up clinic visits. Kaplan-Meier analysis was used to assess the relationship between smoking cessation, mortality, and amputation-free survival.Results: Among 739 patients (423 men and 316 women; mean age, 60 +/- 12 years), 204 (28%) remained active smokers at the time of lower extremity angiography. At the time of angiography, the mean number of cigarettes smoked per day was 16 +/- 10, and the mean pack-years was 40 +/- 25. During the course of the subsequent year, 61 patients (30%) successfully quit smoking and maintained continued abstinence. Baseline medication use between groups did not differ significantly. The mean ankle-brachial index was also similar for quitters vs nonquitters (0.53 +/- 24 vs 0.49 +/- 0.22; P = .3). During follow-up to 5 years, patients who quit smoking had significantly lower all-cause mortality (14% vs 31%; hazard ratio, 0.40; 95% confidence interval, 0.18-0.90) and improved amputation-free survival (81% vs 60%; hazard ratio, 0.43, 95% confidence interval, 0.22-0.86) compared with patients who continued smoking, with most of the difference driven by reduced mortality among patients who quit smoking. The findings remained significant on multivariable analysis.Conclusions: Approximately one-third of active smokers with peripheral artery disease successfully quit smoking