不可思议：吸烟使心肌梗死患者预后更好？
较低。通过多变量logistic回归分析，在第8个月的临床事件中，吸烟率是死亡率的独立预测因子[比值比（OR）0.26，95％可信区间（CI）0.09-0.82，P = 0.021]，但它未能成为心源性猝死（OR 0.38，95％CI 0.09-1.56，P =0.177）的独立危险因素。经皮冠状动脉介入治疗（PCI）患者的亚组分析显示，吸烟是主要严重不良心脏事件发生率较低的独立预测因素（OR 0.47，95％CI 0.23-0.97，P = 0.041）。
结论：在本研究中，年轻的急性心肌梗死患者吸烟似乎预示着更好的临床结果，提示这样的患者中可能存在“吸烟者矛盾现象”。进一步的研究旨在阐明其中的机制，以保证得到明确的结论。
Is there smoker paradox in young patients with acute myocardial infarction?
Authors:
K.-Y. Chen (Cardiology Department, the Second Hospital of Tianjin Medical University, Tianjin /China, People＇s Republic of), S.W. Rha (Korea University Guro Hospital, Seoul /Korea, Republic of), Y.-J. Li (Cardiology Department, Nankai Hospital, Tianjin Medical University, Tianjin /China, People＇s Republic of), B.-G. Choi (Korea University Guro Hospital, Seoul /Korea, Republic of), C.-U. Choi (Korea University Guro Hospital, Seoul /Korea, Republic of), E.-J. Kim (Korea University Guro Hospital, Seoul /Korea, Republic of), C.-G. Park (Korea University Guro Hospital, Seoul /Korea, Republic of), H.-S. Seo (Korea University Guro Hospital, Seoul /Korea, Republic of), D.-J. Oh (Korea University Guro Hospital, Seoul /Korea, Republic of), M.-H. Jeong (Chonnam National University Hospital, Gwangju /Korea, Republic of)
Topic(s):
Tobacco
Citation:
European Heart Journal ( 2011 ) 32 ( Abstract Supplement ), 379-380
Background: There has been a continuous debate regarding "smoker＇s paradox" in patient (pts) with acute myocardial infarction (AMI). Because smokers have been found significantly younger than non-smokers, which might be a major confounding factor, we evaluated the "smoker＇s paradox" in young pts with AMI in Korea Acute Myocardial Infarction Registry (KAMIR).
Methods: AMI pts who were ≤45 year-old were considered young pts. Out of 11,592 eligible AMI pts, 1,218 (10.5％) pts who were ≤45 year-old including 990 smokers and 228 non-smokers were enrolled into the present analysis. The clinical outcomes at 8 months were compared between the smokers and non-smokers.
Results: Baseline clinical characteristics showed that smoker were more likely to be male (97.9％ vs. 72.4％, P<0.001), and had a higher rate of ST-segment elevation myocardial infarction (71.3％ vs. 59.5％, P=0.001) as compared with non-smokers. The clinical outcomes at 8 months showed that young smokers had a significantly lower incidence of total death (1.3％ vs. 4.4％, P=0.005) and a trend toward lower incidence of cardiac death (1.0％ vs. 2.6％, P=0.096) as compared with non-smokers. Multivariable logistic analysis showed current smoking was an independent predictor for lower incidence of total death [odd ratio (OR) 0.26, 95％ confidence interval (CI) 0.09 to 0.82, P=0.021] at 8 months. But it failed to be an independent risk factor for cardiac death (OR 0.38, 95％ CI 0.09 to 1.56, P=0.177). Subgroup analysis in the pts with percutaneous coronary intervention (PCI) showed that current smoking was an independent predictor for lower incidence of total major adverse cardiac events (OR 0.47, 95％ CI 0.23 to 0.97, P=0.041) at 8 months.
Conclusions: In the present study, current smoking seems to be associated with better clinical outcomes in young pts with AMI, suggesting "Smoker＇s Paradox" might exist in such subset of pts. Further studies designed to elucidate the mechanisms behind it will be warranted to get definite conclusions.
