吸烟对微创直接冠状动脉搭桥术结局的影响,Journal of Cardiothoracic Surgery

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吸烟对微创直接冠状动脉搭桥术结局的影响
Journal of Cardiothoracic Surgery ( IF 1.5 ) Pub Date : 2023-01-20 , DOI: 10.1186/s13019-023-02104-9
Youssef Shahin ₁ , Ján Gofus ₁ , Jan Harrer ₁ , Zdeněk Šorm ₁ , Martin Voborník ₁ , Eva Čermáková ₂ , Petr Smolák ₁ , Jan Vojáček ₁

Affiliation

吸烟与传统冠状动脉手术后并发症风险增加有关。然而，吸烟对微创冠状动脉手术术后并发症风险的影响仍有待研究。我们的目的是分析术前吸烟状况对微创直接冠状动脉旁路移植术 (MIDCAB) 在单独手术血运重建或经皮冠状动脉介入治疗的情况下的短期和长期结果的影响。这是一项对 2006 年至 2020 年间在我们机构接受 MIDCAB 的所有患者进行的回顾性观察研究。患者分为三组：活跃吸烟者、手术前戒烟至少 1 个月的戒烟者和非吸烟者。使用常规统计方法比较各组。然后进行多变量分析，发现显着差异以消除偏差。在整个研究期间，541 名患者接受了 MIDCAB，其中 135 名 (25%) 是活跃吸烟者，183 名 (34%) 是戒烟者，223 名 (41%) 是非吸烟者。吸烟者接受手术的年龄更小 (p < 0.0001)，更常有心肌梗塞 (p < 0.001)、外周动脉疾病 (p < 0.001) 和慢性阻塞性肺病 (p < 0.0001) 病史。使用多变量分析，主动吸烟被确定为需要紧急血运重建（比值比 2.36 [1.00–5.56]，p = 0.049）和肺部并发症（包括气胸、呼吸道感染、呼吸功能障碍、皮下气肿和慢性阻塞性肺病的恶化；比值比 2.84 [1.64–4.94]，p < 0.001）。术前吸烟状况不影响长期生存 (p = 0.83)。在我们的研究中，活跃的吸烟者在更年轻的时候就诊于 MIDCAB，并且更常有动脉粥样硬化疾病的迹象（心肌梗塞和外周动脉疾病的病史）。发现主动吸烟是术后肺部并发症的最重要危险因素，并且还与诊断时更频繁地需要紧急手术有关。术后长期生存不受术前吸烟状况的影响。术前吸烟状况不影响长期生存 (p = 0.83)。在我们的研究中，活跃的吸烟者在更年轻的时候就诊于 MIDCAB，并且更常有动脉粥样硬化疾病的迹象（心肌梗塞和外周动脉疾病的病史）。发现主动吸烟是术后肺部并发症的最重要危险因素，并且还与诊断时更频繁地需要紧急手术有关。术后长期生存不受术前吸烟状况的影响。术前吸烟状况不影响长期生存 (p = 0.83)。在我们的研究中，活跃的吸烟者在更年轻的时候就诊于 MIDCAB，并且更常有动脉粥样硬化疾病的迹象（心肌梗塞和外周动脉疾病的病史）。发现主动吸烟是术后肺部并发症的最重要危险因素，并且还与诊断时更频繁地需要紧急手术有关。术后长期生存不受术前吸烟状况的影响。并且还与诊断时更频繁地需要紧急手术有关。术后长期生存不受术前吸烟状况的影响。并且还与诊断时更频繁地需要紧急手术有关。术后长期生存不受术前吸烟状况的影响。

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Impact of smoking on the outcomes of minimally invasive direct coronary artery bypass

Tobacco smoking has been associated with an increased risk of complications after conventional coronary surgery. However, the impact of smoking on the risk of postoperative complications in minimally invasive coronary surgery is yet to be studied. We aimed to analyze the impact of the preoperative smoking status on the short- and long-term outcomes of minimally invasive direct coronary artery bypass grafting (MIDCAB) in the context of isolated surgical revascularization or in association with percutaneous coronary intervention. This was a retrospective observational study of all patients undergoing MIDCAB at our institution between 2006 and 2020. Patients were divided into three groups: active smokers, ex-smokers who have quit smoking for at least 1 month before surgery, and non-smokers. The groups were compared using conventional statistical methods. Multivariate analysis was then performed where significant differences were found to eliminate bias. Throughout the study period, 541 patients underwent MIDCAB, of which 135 (25%) were active smokers, 183 (34%) were ex-smokers, and 223 (41%) were non-smokers. Smokers presented for surgery at a younger age (p < 0.0001), more frequently with a history of myocardial infarction (p < 0.001), peripheral artery disease (p < 0.001) and chronic obstructive pulmonary disease (p < 0.0001). Using multivariate analysis, active smoking was determined to be a significant risk factor for the need of urgent revascularization (odds ratio 2.36 [1.00–5.56], p = 0.049) and the composite of pulmonary complications (including pneumothorax, respiratory infection, respiratory dysfunction, subcutaneous emphysema and exacerbation of chronic obstructive pulmonary disease; odds ratio 2.84 [1.64–4.94], p < 0.001). Preoperative smoking status did not influence the long-term survival (p = 0.83). In our study, active smokers presented for MIDCAB at a younger age and more often with signs of atherosclerotic disease (history of myocardial infarction and peripheral artery disease). Active smoking was found to be the most significant risk factor for postoperative pulmonary complications, and is also associated with a more frequent need for urgent surgery at diagnosis. Long-term postoperative survival is not affected by the preoperative smoking status.

更新日期：2023-01-21

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