The Study Of Management In Smoking Patients After Interventional Therapy And Its Relationship With Prognosis

【Objective】Smoking is an important risk factor for coronary heart disease.A large number of studies have shown that smoking has an impact on the pathogenesis of coronary heart disease and the occurrence and development of the disease.At the same time,studies have shown that quitting smoking can significantly reduce the risk of death from coronary heart disease.However,some studies have found "the paradox of smokers" and suggested that smoking can improve the short-term prognosis of patients with coronary heart disease.Previous studies of smoking status were mostly limited to baseline data and were not collected again at follow-up,but smoking patients may quit smoking or relapse after coronary intervention.Therefore,the purpose of this study was to analyze the smoking status of patients with coronary heart disease,and to perform standardized follow-up and smoking management on patients after interventional therapy,and to investigate the relationship between postoperative smoking status and prognosis.【Methods】Collection of postoperative PCI cases from October 2013 to August 2016 at the Department of Cardiology Outpatient Clinic of the First Affiliated Hospital of Dalian Medical University,a total of 913 cases were included in this study.According to smoking history and smoking status at follow-up,they were divided into 3 groups: 432 in the non-smoking group(referring to never smoke),194 in the non quit-smoking group(referring to smoke before and after surgery),and 287 in the quit-smoking group(referring to Preoperative smoking and postoperative cessation).The primary end points of the study was MACE events(including all-cause death,non-fatal myocardial infarction,revascularization therapy)and the secondary end points was composite end points (including all-cause death,non-fatal myocardial infarction,revascularization therapy,recurrent angina,heart failure and rehospitalization of coronary heart disease).【Results】A total of 913 patients were enrolled in this study.481 patients were smokers before surgery,accounting for 52.7%.The smoking rate was 68.3% for men and 2.8% for women.There were 287 patients quitting smoking after PCI,but 194 patients continued to smoke,accounting for 21.2%.The average number of cigarettes per day before surgery was(22.10±12.37),and the average number of cigarettes smoked per day was(15.09±10.16).Baseline data showed that the smoking group was younger than the nonsmoking group and more males.The proportion of patients with hypertension and diabetes was lower,but the incidence of acute myocardial infarction was higher than that of the non-smoking group.Comparison of follow-up data between groups showed that the risk of non-fatal myocardial infarction in the quit-smoking group was still higher than that of the non-smoking group,while other cardiovascular adverse events were not statistically different.The incidence of recurrence of angina pectoris,nonfatal myocardial infarction,revascularization,rehospitalization of coronary heart disease,and all-cause death was higher in the non quit-smoking group than in the quit-smoking group.Multivariate Cox regression analysis showed that there was no significant difference between the risk of MACE events and composite end point events in the quit-smoking group and the non-smoking group.The risk of MACE events was significantly higher in the non quit-smoking group than in the non-smoking group(HR=2.42,95% CI 1.65 to 3.54,P<0.001),and the risk of a composite end point event was also increased(HR=2.02,95% CI 1.51 to 2.72,P<0.001).The subgroup analyses the prognosis of patients with different clinical types.The results show that compared with unstable angina,smoking has a more significant impact on the prognosis of patients with acute myocardial infarction.The subgroup analysis of this study found that with the increase in the number of daily cigarettes after surgery,the risk of MACE events and composite end point events was also significantly increased.【Conclusion】1.Compared with the non-smoking group,the smoking group was younger,more male,and had fewer risk factors such as hypertension and diabetes,but the incidence of acute myocardial infarction was high.2.There was no significant difference in the risk of MACE and composite end point events between the quit-smoking group and the non-smoking group,but the risk of non-fatal myocardial infarction in the quitsmoking group was higher than the non-smoking group.The risk of MACE events and composite end points in the non quit-smoking group were higher than the non-smoking group and the quit-smoking group.3.Smoking is an independent risk factor for the prognosis of patients after PCI.Quitting smoking can significantly improve the prognosis of patients with coronary heart disease.4.Compared with the UA patients,smoking has a more significant effect on the prognosis of AMI patients.5.There is a significant doseeffect relationship between the number of daily cigarette smoking and the prognosis of patients with coronary heart disease.