Impact of Smoking on Clinical Outcomes in ST-Elevated Myocardial Infarction Patients with Small Infarct Related Coronary Vessels

Yıl 2020, Cilt: 10 Sayı: 1, 121 - 127, 16.03.2020

Kahraman Coşansu , Mustafa Çağın Üreyen

https://doi.org/10.31832/smj.637410

Öz

Objective: In
the literature, there is no data for the comparative efficacy of smoking status
in ST-segment elevation myocardial infarction(STEMI) patients with small vessel
coronary artery disease(CAD) on clinical outcomes.The aim of this study was to
evaluate the in-hospital mortality and long-term outcomes of STEMI patients
with small vessel coronary artery disease according to smoking status.

Materials and Methods: Between
January 2014 and May 2017,388 consecutive STEMI patients with small vessel CAD
were included in this retrospective study.The patients were classified into two
groups according to status of smoking, as smokers (n =181) and non-smokers (n =207).The
primary outcome was major adverse cardiac events(MACE).The secondary end-point
included in-hospital mortality.

Results: During the follow-up
of 24 months, MACE occurred in 25(14.1 %) patients in smokers and 12(6.3 %)
patients in non-smokers(p: 0.014).The target-lesion revascularization(TLR), target-vessel
revascularization(TVR) and myocardial infarction(MI) rates was found
significantly higher in the smoker group as compared with the non-smoker
group(p: 0.049, p: 0,012, p: 0,025, respectively).The rate of in-hospital
mortality was found significantly lower in smokers (p: 0.04).In multivariate
Cox analysis for 2-year MACE, after accounting for all covariables, no-smoking
was associated with 58% decreased risk in the small vessel CAD population (HR:
0.42, 95% CI: 0.21-0.84).Moreover, no-smoking was associated with a decreased
TLR (HR: 0.38, 95% CI: 0.14-0.99),TVR (HR:0.31, 95% CI: 0.12-0.79) and MI(HR:
0.41, 95% CI: 0.19-0.89) risk at 2-years follow up.

Conclusions: In
our real-world registry of patients who underwent primary percutaneous coronary
intervention(PPCI),smokers had lower in-hospital mortality,but poorer outcomes
during 2-year follow-up. 

Anahtar Kelimeler

Primary percutaneous coronary intervention; ST elevation myocardial infarction; smoking status; small vessel coronary artery.

İnfarktla İlişkili Küçük Koroner Damarları Olan ST-Yükselmeli Miyokard İnfarktüslü Hastalarda Sigara İçiminin Klinik Sonuçlar Üzerine Etkisi

Öz

Amaç: Literatürde ST-segment yükselmeli miyokard infarktüsünde(STEMI) sigara
içimi durumunun, küçük damar koroner arter hastalığı(KAH) olan hastalarda
klinik sonuçlar üzerinde karşılaştırmalı etkinliği konusunda veri yoktur.
Bu çalışma, STEMI ile başvuran küçük damar koroner
arter hastalığı olan hastaların sigara içip içmemesine göre   hastane içi mortalite ve uzun dönem
sonuçlarını değerlendirmeyi amaçlamıştır.

Gereç ve Yöntemler: Bu retrospektif çalışmaya Ocak 2014 ve Mayıs 2017
arasında, küçük damar KAH olan 388 ardışık STEMI hastası dahil edildi. Hastalar sigara içme durumuna göre sigara içenler (n=181)
ve sigara içmeyenler (n=207) olarak iki gruba ayrıldı. Birincil son nokta majör
olumsuz kardiyak olaylar (MACE) idi. İkincil son nokta hastane içi mortaliteyi
içeriyordu.

Bulgular: 24 aylık takipte sigara içenlerde 25(%14,1) hastada,
sigara içmeyenlerde 12(%6,3) hastada MACE gelişti(p:0,014). Sigara içen grupta hedef lezyon revaskülarizasyonu(TLR),
hedef damar revaskülarizasyonu(TVR) ve miyokard infarktüsü(MI) oranları sigara
içmeyenlere göre anlamlı derecede yüksek bulundu Sırasıyla (p:0.049, p:0,012,
p:0,025). Hastane içi mortalite oranı
sigara içenlerde anlamlı derecede düşük bulundu (p: 0.04). 2 yıllık MACE için çok değişkenli Cox analizinde,
tüm değişkenler için hesap yapıldıktan sonra, sigara içilmemesi, küçük damar
KAH popülasyonunda %58 oranında azalmış risk ile ilişkili bulunmuştur (HR:
0.42, %95 CI: 0.21-0.84). Ayrıca sigara içilmemesi 2 yıllık takipte, TLR (HR:
0.38, %95 CI: 0.14-0.99), TVR (HR: 0.31, %95 CI: 0.12-0.79) ve MI (HR: 0.41, %95
CI: 0,19-0,89) için daha düşük bir risk ile ilişkilendirildi.

Sonuç: Gerçek yaşam kayıt çalışmamızda
primer perkutan koroner girişim (PPKG) yapılan küçük
damar KAH olan hastalarda sigara içenlerin
hastane içi ölüm oranları daha düşük saptandı, ancak 2 yıllık takipte daha kötü
sonlanımları vardı.

Anahtar Kelimeler

Primer perkütan koroner girişim; ST yükselmeli miyokard infarktüsü; sigara içme durumu; küçük damar koroner arter.

Kaynakça

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