Smoking, Colchicine and Postoperative Outcomes in Thoracic Surgery: Post Hoc Analysis of the COP-AF Randomized Controlled Trial

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2025-07-01 DOI:10.1016/j.cjco.2025.04.008

Sandra Ofori MBBS, PhD , Michael K. Wang MD , Ekaterine Popova MD, PhD , William F. McIntyre MD, PhD , Matthew Chan MBBS, PhD , Daniel I. Sessler MD , Veronesi Giulia MD , Mark Warwas MD , Kumar Balasubramanian MSc , Vikas Tandon MD , Christain Finley MD, MPH , Gonzalez Tallada Anna MD , Juan Cata MD , Sadeesh Srinathan MD , Cara Reimer MD , Sean McLean MD, FRCPC , Juan Carlos Trujillo MD, PhD , Edith Fleischmann MD , Luca Voltolini MD , Patricia Cruz MD , David Conen MD, MPH

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Abstract

Background

To determine, among patients who underwent major noncardiac thoracic surgery, the association between smoking and perioperative atrial fibrillation (AF) and myocardial injury after noncardiac surgery (MINS), and whether the effect of colchicine use on these outcomes varied by smoking status.

Methods

This study is a subgroup analysis of the Colchicine for the Prevention of Perioperative Atrial Fibrillation (COP-AF) randomized clinical trial. A total of 3209 participants who underwent major noncardiac thoracic surgery were randomized to receive colchicine, 0.5 mg twice daily, or identical placebo, for 10 days starting 2-4 hours before surgery. The co-primary outcomes were clinically significant perioperative AF and MINS during the 14-day follow-up.

Results

A total of 687 (21.4%) were current smokers, 1577 (49.1%) were former smokers, and 945 (29.5%) were never smokers. AF occurred in 7.7%, 7.6%, and 5.3%, and MINS occurred in 21.0%, 19.7%, and 17.6% of current, former, and never smokers, respectively. Compared to never smokers, the adjusted hazard ratio for AF was 1.72 (95% confidence interval [CI] 1.07-2.77, P = 0.02) in current smokers and 1.46 (95% CI 0.99-2.16, P = 0.06) in former smokers, and the adjusted hazard ratio for MINS was 1.16 (95% CI 0.87-1.54, P = 0.32) in current smokers and 1.02 (95% CI 0.81-1.28, P = 0.88) in former smokers. No interaction occurred between smoking status and colchicine allocation for AF (interaction P, 0.82) or MINS (interaction P, 0.08).

Conclusions

Current smoking was associated with a small but increased risk of perioperative AF but not MINS after thoracic surgery. The effect of colchicine use on either outcome was not modified by smoking status.

Clinical Trial Registration

NCT03310125

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吸烟、秋水仙碱与胸外科术后预后：copd - af随机对照试验的事后分析

背景：在接受重大非心脏胸外科手术的患者中，确定吸烟与围手术期心房颤动（AF）和非心脏手术后心肌损伤（MINS）之间的关系，以及秋水仙碱的使用对这些结果的影响是否因吸烟状况而异。方法本研究是秋水仙碱预防围手术期心房颤动（COP-AF）随机临床试验的亚组分析。共有3209名接受重大非心脏胸外科手术的参与者随机接受秋水仙碱，0.5 mg，每日两次，或相同的安慰剂，从手术前2-4小时开始，为期10天。在14天的随访中，共同主要结局是围手术期有临床意义的AF和MINS。结果现吸烟者687人（21.4%），已戒烟者1577人（49.1%），未吸烟者945人（29.5%）。AF的发生率分别为7.7%、7.6%和5.3%，而min的发生率分别为21.0%、19.7%和17.6%。与从不吸烟者相比，当前吸烟者AF的校正危险比为1.72(95%可信区间[CI] 1.07-2.77, P = 0.02)，前吸烟者AF的校正危险比为1.46 (95% CI 0.99-2.16, P = 0.06)，当前吸烟者min的校正危险比为1.16 (95% CI 0.87-1.54, P = 0.32)，前吸烟者min的校正危险比为1.02 （95% CI 0.81-1.28, P = 0.88）。吸烟状况与秋水仙碱分配对AF（相互作用P， 0.82）或min（相互作用P， 0.08）没有相互作用。结论当前吸烟与围手术期房颤风险虽小但增加有关，而与胸外科术后min风险无关。使用秋水仙碱对两种结果的影响不受吸烟状况的影响。临床试验注册号nct03310125

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