吸烟对MINOCA患者的影响。

IF 4.4 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Hersh Osman, Clara Schlettert, Daniel Materzok, Muharrem Akin, Mohammad Abumayyaleh, Ibrahim Akin, Andreas Mügge, Assem Aweimer, Nazha Hamdani, Ibrahim El-Battrawy
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引用次数: 0

摘要

背景:近年来对心肌梗死合并非阻塞性冠状动脉疾病(MINOCA)患者进行了大量研究,重点关注其预后、患病率和易感危险因素。然而,关于有吸烟史的MINOCA患者的基线特征和结果的信息仍然缺乏。本研究试图检查一个假定的MINOCA队列(包括有吸烟史的个体)的住院并发症和基线特征。方法:在本研究中,共有373名患者(85名吸烟者和283名非吸烟者)在2010年至2021年期间被纳入,这些患者表现出肌钙蛋白水平升高,但没有阻塞性冠状动脉疾病的证据。MINOCA患者必须符合基于“心肌梗死第四通用定义”的急性心肌梗死(AMI)的修改标准,包括肌钙蛋白水平上调或下调,且至少有一个值超过第99个百分位数,以及梗死的临床证据(例如缺血性心电图改变,心肌损伤或冠状动脉血栓)。此外,未进行干预的主要心外膜血管狭窄小于50%的患者和其他诊断类似肌钙蛋白阳性的非阻塞性冠状动脉疾病的患者被排除在外。应当指出的是,有5名患者的吸烟状况数据无法获得。本研究的主要目的是评估各种院内事件的发生情况,包括肺水肿、有创通气、心源性休克、中风、心肺复苏、恶性心律失常、室上性心律失常、左室血栓、血栓栓塞事件和院内死亡率。此外,在11年的随访期间对长期心血管事件进行了评估。结果:吸烟者和非吸烟者的基线人口统计数据显示,室上性心律失常的患病率存在显著差异,尤其是心房颤动(5.8% vs. 17.4%;p = 0.020),糖尿病(DM) (10.5% vs. 19.7%;P = 0.051),肾脏疾病(9.3% vs. 15.9%;p = 0.075)和慢性阻塞性肺疾病(COPD) (18.6% vs. 10.8%;p = .057)。医院内心血管事件的发生率和死亡率在吸烟者和非吸烟者之间具有可比性。然而,与吸烟者相比,不吸烟者经历了更高的长期心血管事件发生率。长期结果的多变量Cox分析表明,50岁以下的吸烟者有更有利的结果。然而,糖尿病、室上性心动过速、肺部疾病和神经系统疾病的存在都与长期预后降低有关。结论:尽管吸烟者的长期健康结果相对优于非吸烟者,但这种对比可归因于非吸烟人群中心血管合并症的发生率增加和年龄分布。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Impact of smoking in MINOCA patients.

Background: Considerable research has been conducted in recent years on patients afflicted with myocardial infarction with nonobstructive coronary disease (MINOCA), focussing on its prognosis, prevalence and predisposing risk factors. Nevertheless, there remains a dearth of information regarding the baseline characteristics and outcomes of MINOCA patients with a history of smoking. This study endeavours to examine the in-hospital complications and baseline characteristics of a presumed MINOCA cohort comprising individuals with a history of smoking.

Methods: In this study, a total of 373 patients (85 current smokers and 283 non-smokers), who exhibited elevated troponin levels but had no evidence of obstructive coronary artery disease, were enrolled between 2010 and 2021. MINOCA patients had to fulfil the modified criteria for acute myocardial infarction (AMI) based on the 'Fourth Universal Definition of Myocardial Infarction', including an up- or downregulated troponin level with at least one value exceeding the 99th percentile, along with clinical evidence of infarction (e.g. ischaemic ECG changes, myocardial damage or coronary thrombus). Additionally, patients with less than 50% stenosis of a major epicardial vessel without intervention and those with alternative diagnoses mimicking troponin-positive nonobstructive coronary disease were excluded. It should be noted that there were five patients for whom data regarding smoking status were not available. The primary objective of this investigation was to evaluate the occurrence of various in-hospital events, including pulmonary oedema, invasive ventilation, cardiogenic shock, stroke, cardiopulmonary resuscitation, malignant cardiac arrhythmias, supraventricular arrhythmias, left ventricular thrombus, thromboembolic events and in-hospital mortality. Additionally, long-term cardiovascular events were assessed over an 11-year follow-up period.

Results: Baseline demographics in smokers and non-smokers showed notable differences in the prevalence of supraventricular arrhythmia, particularly atrial fibrillation (5.8% vs. 17.4%; p = .020), diabetes mellitus (DM) (10.5% vs. 19.7%; p = .051), kidney disease (9.3% vs. 15.9%; p = .075) and chronic obstructive pulmonary disease (COPD) (18.6% vs. 10.8%; p = .057). The occurrence of in-hospital cardiovascular events and mortality rates was found to be comparable between smokers and non-smokers. However, non-smokers experienced a higher incidence of long-term cardiovascular events compared to smokers. A multivariable Cox analysis for long-term outcomes indicated that individuals under the age of 50 who were smokers had a more favourable outcome. Nonetheless, the presence of DM, supraventricular tachycardia, pulmonary disease and neurological disease were all associated with a diminished long-term prognosis.

Conclusion: Although the long-term health outcomes for smokers are comparatively superior to those of non-smokers, this contrast can be attributed to the increased incidence of cardiovascular comorbidities and the older age distribution within the non-smoking population.

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来源期刊
CiteScore
9.50
自引率
3.60%
发文量
192
审稿时长
1 months
期刊介绍: EJCI considers any original contribution from the most sophisticated basic molecular sciences to applied clinical and translational research and evidence-based medicine across a broad range of subspecialties. The EJCI publishes reports of high-quality research that pertain to the genetic, molecular, cellular, or physiological basis of human biology and disease, as well as research that addresses prevalence, diagnosis, course, treatment, and prevention of disease. We are primarily interested in studies directly pertinent to humans, but submission of robust in vitro and animal work is also encouraged. Interdisciplinary work and research using innovative methods and combinations of laboratory, clinical, and epidemiological methodologies and techniques is of great interest to the journal. Several categories of manuscripts (for detailed description see below) are considered: editorials, original articles (also including randomized clinical trials, systematic reviews and meta-analyses), reviews (narrative reviews), opinion articles (including debates, perspectives and commentaries); and letters to the Editor.
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