| Part1Impact of Smoking status on In-hospital and long-term Complications in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary InterventionBackgroundSmoking is a risk factor for many diseases,including cardiovascular disease,and increases mortality.The rate of cardiovascular death increased by 2-3 times more than that of nonsmokers.Studies in patients with acute coronary syndrome(ACS)have shown that patients with smoking have a worse prognosis than nonsmokers.However,some studies in patients with acute myocardial infarction(AMI)have shown that patients with smoking have a better prognosis than nonsmokers,a phenomenon known as the"smoking paradox." At present,the impact of smoking on the prognosis of ACS patients undergoing percutaneous coronary intervention(PCI)is rarely reported,especially in the long-term follow-up study of large samples.ObjectiveThe aim of this study was to investigate the effect of smoking on in-hospital and long-term prognosis of patients undergoing percutaneous coronary intervention in ACS.MethodsThe study included 6431 ACS patients who were involved in the interventional treatment at Fu Wai Hospital of Chinese Academy of Medical Sciences from January 2013 to December 2013.The diagnostic criteria of ACS were defined according to the World Health Organization(WHO).Patients were divided into non-smoking group(including never-smokers and former smokers)and smoking group according to their smoking status at admission.After an average follow-up of 2 years,Kruskal-Willis H method was used to compare differences in continuous variables,chi-squared tests or Fisher's exact test were used to compare differences in categorical variables.Chi-square test and Kaplan-Meier method were used to compare the primary end points Incident:All-cause death;secondary end point:Cardiogenic death,recurrent myocardial infarction,stroke,bleeding,stent thrombosis,revascularization and MACCE.Cox proportional hazards regression model was used to predict predictors of endpoint events.All P values in this study were two-tailed P-values.For differences between the two groups,P<0.05 was defined as statistically significant.SPSS 20.0 software was used for statistical analysis.ResultsAfter Fuwai Hospital interventional catheterization core laboratory data system retrieval,screening in January 2013-December in our hospital received PCI in 6431 ACS patients.According to the state of smoking on admission,the patients were divided into non-smoking group(including 2673 patients who never smoked and those who had quit smoking)and smoking group(3758 patients).The comparison found that patients in smokers were younger,men were predominant,their body mass index was higher,their average length of hospital stay was shorter,and the proportion of patients with hypertension,diabetes and chronic renal insufficiency was significantly lower than that of non-smokers,while those with coronary heart disease History,old myocardial infarction,and the proportion of previous PCI was significantly higher than non-smoking group.The results of coronary angiography and interventional treatment showed that the proportion of transradial puncture in smoking group was significantly higher than that of non-smoking group,and the proportion of femoral artery puncture was significantly lower in smoking group than in non-smoking group.The chronic occlusive disease(CTO),preoperative TIMI Grade 0 blood flow and thrombus aspiration were significantly higher than those in non-smoking group.The incidence of antegrade and descending coronary artery involvement in smoking group was lower than that of non-smoking group.The diameter of stenting in smoking group was larger than that in sub-smoking group.All-cause and cardiac death in smokers during hospitalization were significantly lower than those in nonsmokers(0.1%vs.0.4%,P = 0.015;0.1%vs.0.4%,P=0.048);while in hemorrhage,stroke,Thrombosis and the incidence of new myocardial infarction no significant difference between the two groups.A total of 1430 patients(99.7%)were followed up for an average of 760 days.The 2-year follow-up results showed that the incidence of stroke and cardiogenic death was significantly lower in smokers than in nonsmokers(1.2%vs.1.8%,P = 0.036;0.6%vs.1.1%,P = 0.026)There was no significant difference between the two groups.Multivariate Logistic regression analysis of all-cause and cardiac death during hospitalization showed that independent predictors of all-cause mortality during hospitalization were left main(LM)disease and ST-segment elevation myocardial infarction(STEMI);independent predictors of cardiac death were old myocardial infarction(OMI),LM disease,and STEMI;Independent predictors of cardiac death at 2-year follow-up were age,left ventricular ejection fraction(LVEF)<40%,chronic renal insufficiency,OMI,and STEMI;independent predictors of stroke were age and cerebrovascular disease.ConclusionFor ACS patients undergoing coronary intervention,cardiac death and all-cause mortality were significantly lower in smokers than in non-smokers;2-year stroke and cardiac death was significantly lower in smokers than in non-smokers.Multivariate analysis show that smoking is not an independent predictor of cardiac death,all-cause mortality and stroke in these patients.Part 2Effect of Smoking on High on-treatment Platelet Reactivity in Patients Undergoing coronary intervention and its Effect on Long-term PrognosisBackgroundAspirin and clopidogrel have become standard antiplatelet strategies in patients with acute coronary syndrome(ACS)and procutaneous coronary intervention(PCI).However,some patients even experienced high on-treatment platelet reactivity(HTPR)even after double-antiplatelet therapy,resulting in adverse ischemic events such as death,myocardial infarction and stroke.Platelet function tests,such as thromboela-stogram(TEG),are important ways to identify patients with HTPR and provide a basis for individualized antiplatelet therapy to improve clinical outcomes.At present,there is still controversy about the influence of smoking on the coagulation system,platelet function and the effect of antiplatelet therapy.The relationship between HTPR detected by TEG and smoking and prognosis is also controversial,especially the lack of clinical data on large-scale coronary artery disease(CAD)in China.ObjectiveThe aim of this study was to investigate the effect of smoking on HTPR and the relationship between HTPR and clinical long-term prognosis by analyzing the long-term 2-year follow-up results of single-center and large-sample PCI patients with coronary heart disease,which can provide the basis for clinical individualized treatment.MethodsThe study was consecutively included in patients with coronary heart disease who underwent PCI from Fuwai Hospital of Chinese Academy of Medical Sciences between January 2013 and December 2013 and had a report of thromboelastography at 12-72h afrer PCI.The smoking status was divided into smoking group(n = 2604)and non-smoking group(n = 2002).According to the result of thromboelastography,patients were divided into HTPR group and non-HTPR group.Thromboelastogram-ADP-induced fibrin clot strength(TEG-MAADP)>47 mm was defined as HTPR.Two-year follow-up of major adverse cardiac and cardiovascular events(MACCE)was observed,including death,myocardial infarction,revascularization,stent thrombosis and stroke.The independent risk factors of HTPR were analyzed by Logistic regression model and the independent predictors of adverse events were analyzed by Cox regression model.Statistical analysis was performed using SPSS 20.0 statistical software;P<0.05 was considered statistically significant.ResultsIn the PCI patients,1328(28.84%)patients had HTPR,there was no significant difference in the incidence of HTPR between smoking group and non-smoking group before and after propensy score(29.4%vs.28.1%,P = 0.351;29.3%vs.27.7%,P =0.348).After 2 years of follow-up,the incidence of death,myocardial infarction,revascularization and major adverse cardiac events The incidence of cerebrovascular events(MACCE)showed no significant difference between none-HTPR and HTPR groups(P>0.05).After adjustment for the propensity score,there wwere still no significant difference between the two groups(P>0.05).Conclusion(1)There was no significant correlation between smoking and platelet hyperreactivity found in the thrombus elastography in Chinese patients with coronary artery disease who underwent interventional therapy;(2)2-year follow-up results showed that platelet reactivity does not affect its clinical prognosis. |
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