冠心病患者血管重建后吸烟状态对临床预后的影响

发布时间：2018-08-02 09:51

【摘要】：目的探讨冠心病患者血管重建后吸烟状态对其长期临床预后的影响。方法将893例冠心病患者根据血管重建术前及术后的吸烟状态分为3组:不吸烟组(n=458)、戒烟组(n=287)及吸烟组(n=148),详细记录随访时主要不良心脑血管事件(MACCE)的发生情况。Kaplan-Meier生存分析描述术后累计生存率,并比较吸烟状态对全因性死亡及MACCE的影响,Cox多元逐步回归分析全因性死亡及MACCE的影响因素。结果平均随访时间约为27个月,术后吸烟率较术前吸烟率明显降低(16.57%vs.48.71%),且吸烟组患者较年轻(P0.01);不吸烟组患者多为女性(P0.01),体质量指数(BMI)较小(P0.01)。吸烟组全因性死亡(1.53%vs.1.05%vs.6.76%,P=0.002)和MACCE(4.37%vs.5.23%vs.15.54%,P=0.001)的发生率较高,Cox多元逐步回归分析显示,术后持续吸烟是导致全因性死亡[HR=2.753,95%CI(1.695~4.473),P0.01]和MACCE[HR=1.552,95%CI(1.049~1.754),P=0.001]发生的重要危险因素。结论冠心病患者血管重建后持续吸烟是导致术后发生全因性死亡和MACCE的独立危险因素。
[Abstract]:Objective to investigate the effect of smoking status on long-term clinical prognosis in patients with coronary heart disease (CHD) after revascularization. Methods according to the smoking status before and after revascularization, 893 patients with coronary heart disease were divided into 3 groups: non smoking group (nnf458), smoking cessation group (nnf287) and smoking group (nnf148). The incidence of major adverse cardiovascular and cerebrovascular events (MACCE) during follow-up was recorded in detail. The cumulative survival rate was described by survival analysis. The effects of smoking status on all-cause death and MACCE were compared. Multivariate Cox stepwise regression analysis was used to analyze the influencing factors of all-cause death and MACCE. Results the average follow-up time was about 27 months. The smoking rate after operation was significantly lower than that before operation (16.57 vs 48.71%), and the smoking group was younger (P0.01), the non-smoking group was mostly female (P0.01), and the body mass index (BMI) was smaller (P0.01). The incidence of all-cause death (1.53v s.1.05vs.6.76P0.002) and MACCE (4.37vs.5.23vs.15.54P0.001) in smoking group was higher than that in smoking group. Cox stepwise regression analysis showed that continuous smoking after operation was an important risk factor for overall death [HR2.75395CI (1.6955.473) P0.01] and MACCE [1.55295CI (1.0491.754) P0.001]. Conclusion continuous smoking after revascularization is an independent risk factor for postoperative all-cause death and MACCE in patients with coronary heart disease.
【作者单位】：河南省人民医院心内科监护病房;河南省心血管流行病中心;
【基金】：河南省科技厅重点攻关项目(142102310396)
【分类号】：R541.4

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