药物洗脱支架植入术后基线吸烟状况和10年预后：来自DECADE合作的见解。

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2025-04-28 DOI:10.1016/j.jcin.2024.12.028

Antonia Presch MD , J.J. Coughlan MB, BCh , Sarah Bär MD , Salvatore Brugaletta MD, PhD , Michael Maeng MD, PhD , Sebastian Kufner MD , Luis Ortega-Paz MD, PhD , Lorenz Räber MD, PhD , Karl-Ludwig Laugwitz MD , Lisette Okkels Jensen MD, PhD , Stephan Windecker MD , Kevin Kris Warnakula Olesen MD, PhD , Manel Sabaté MD, PhD , Dik Heg PhD , Adnan Kastrati MD , Salvatore Cassese MD, PhD

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引用次数: 0

摘要

背景：在接受经皮冠状动脉介入治疗（PCI）和药物洗脱支架（DES）植入术的大规模人群中，根据基线吸烟状况调查10年预后的研究很少。目的：作者试图评估基线吸烟状况与PCI植入DES后10年预后之间的关系。方法：我们汇集了来自5个随机试验的个体参与者数据，包括DES植入后随访10年的患者。我们根据受试者在基线时的吸烟状况将其分为两组。主要结果是全因死亡。次要结局包括心血管死亡、心肌梗死（MI）、明确的支架血栓形成（ST）和重复血运重建术（靶病变、靶血管[TVR]或非靶血管）。结果：9527例行PCI合并DES植入的患者被纳入本分析（吸烟n = 2365，不吸烟n = 7162）。多变量调整后，吸烟与全因死亡的高风险相关(HRadj: 1.45；95% CI: 1.33-1.59)，心血管死亡(HRadj: 1.59；95% CI: 1.41-1.80)，明确ST (HRadj: 2.09；95% CI: 1.34-3.26)。在PCI术后的前30天，心肌梗死的风险是相当的，但在吸烟组，从1到10年，心肌梗死的风险显著增加(HRadj: 1.60；95% ci: 1.36-1.90)。吸烟与靶病变血运重建和靶血管血运重建的风险较低有关，但与非靶血管血运重建的风险相当。结论：在接受PCI合并DES的患者中，基线吸烟与死亡、心肌梗死和ST的风险增加有关，但10年内重复血运重建的风险较低。

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Smoking Status at Baseline and 10-Year Outcomes After Drug-Eluting Stent Implantation

Background

Studies investigating 10-year outcomes according to smoking status at baseline in a largescale population undergoing percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation are scarce.

Objectives

The authors sought to assess the association between smoking status at baseline and 10-year outcomes after PCI with DES implantation.

Methods

We pooled individual participant data from 5 randomized trials including patients with 10-year follow-up after DES implantation. We divided participants into 2 groups as per smoking status at baseline. The main outcome was all-cause death. Secondary outcomes included cardiovascular death, myocardial infarction (MI), definite stent thrombosis (ST), and repeat revascularization (of target lesion, target vessel [TVR], or non-target vessel).

Results

A total of 9,527 patients undergoing PCI with DES implantation were included in this analysis, (smoking n = 2,365; nonsmoking, n = 7,162). After multivariable adjustment, smoking was associated with a higher risk of all-cause death (HR_adj: 1.45; 95% CI: 1.33-1.59), cardiovascular death (HR_adj: 1.59; 95% CI: 1.41-1.80), and definite ST (HR_adj: 2.09; 95% CI: 1.34-3.26) over 10 years after PCI. The risk of MI was comparable in the first 30 days after PCI, but increased significantly from 1 to 10 years in the smoking group (HR_adj: 1.60; 95% CI: 1.36-1.90). Smoking was associated with a lower risk of target lesion revascularization and target vessel revascularization, but a comparable risk of non-target vessel revascularization.

Conclusions

In patients undergoing PCI with DES, smoking at baseline is associated with an increased risk of death, MI, and ST, but a lower risk of repeat revascularization through to 10 years.

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来源期刊

JACC. Cardiovascular interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

8.80%

发文量

756

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.