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

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.

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

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.

Keywords:

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

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