Predictors of One-Year Mortality in Smokers with Acute Myocardial Infarction

Abstract

Background/Aims: It is well known that smoking is associated with clinical outcomes in patients with acute myocardial infarction (AMI). In this study, we aimed to predict the one-year mortality in AMI patients that smoked.Methods: Of the AMI patients who were enrolled in the Korean Acute Myocardial Infarction Registry-National Institutes of Health study, 5,110 were current smokers (57.1 ± 11.6 years, male 95%), and these patients were included in the present study. Patients were divided into two groups; group I (survival group, n = 4,844, 56.5 ± 11.3 years, male 95%) and group II (deceased group, n = 266, male 88%). Clinical characteristics, coronary angiographic findings, procedural characteristics, and independent factors related to one-year mortality were analyzed.Results: In group II, the incidence of hypertension and diabetes were significantly higher than in group I, and the patients were significantly older. Patients with history of angina pectoris, myocardial infarction, and heart failure were significantly more common in group II than in group I. Smoking duration and pack-years of smoking were also significantly longer in group II than in group I. Multivariate analysis revealed that creatine > 2 mg/dL, left ventricular ejection fraction < 40%, Killip class ≥ II, age ≥ 65 -370 -years, and post-percutaneous coronary intervention thrombolysis in myocardial infarction (post-PCI TIMI) flow ≤ II were independent factors of mortality during the one-year follow-up.Conclusions: The predictors of one-year mortality in AMI patients with smoking were renal and left ventricular dysfunction, high Killip class, old age, and low post-PCI TIMI flow. (Korean J Med 2018;93:369-378) 서 론 흡연과 간접 흡연은 많은 질병으로 인한 이환율 및 사망 률의 위험요인으로 광범위하게 알려져 있으며[1,2], 관상동 맥질환의 위험요인일 뿐만 아니라[3,4] 공중보건학적으로 예 방 가능한 요인으로 알려져 있다[5]. 한국인 급성 심근경색 증 환자에 대한 등록연구사업인 Korea Acute Myocardial Infarction Registry (KAMIR)의 보고에 의하면 흡연이 우리나 라 급성 심근경색증(acute myocardial infarction, AMI) 환자에 서 중요한 위험인자 중 하나였다[6]. 흡연량과 흡연 기간은 흡연과 간접 흡연에서 심혈관질환 발생의 중대한 위험요인 이다[7]. 흡연은 AMI의 위험요인에도 불구하고 역설적으로 경색 후 사망률이 낮았으며 "smoker's paradox"로 알려져 있 다[7]. 이러한 현상은 관상동맥중재술을 받은 AMI 환자에서 재관류 요법을 시행받은 많은 연구들에서 보고되었다[8-10]. 흡연자는 비흡연자에 비하여 평균 연령이 낮고, 다혈관 질환 이 적고, 좌심실구혈률이 낮으며, 동반 질환이 적은 특성을 보였다[11]. 흡연을 하는 한국인 급성 심근경색증 환자에서 사망률에 영향을 미치는 요인을 파악하고자 하였다. 이 연구는 KAMIR-National Institutes of Health (KAMIR-NIH) [12]에 등록된 환자들 중에서 흡연자를 대상으로 생존군과 사망군으로 분류하여, 각 군 간의 임상적 특징과 관상동맥 조영술 소견 및 1년 사망률과 관련된 사망 예측인자를 알아보고 자 하였다. 대상 및 방법 연구 대상 2011년 11월부터 2015년 12월까지 KAMIR-NIH [12]에 등 록된 13,104예 중 흡연을 하는 5,110예(57.1 ± 11.6세, 남성 95%)를 대상으로 하였다. 그중 흡연자 중에서 생존한 AMI 환자를 I군 4,844예(56.5 ± 11.3세, 남자 95.3%), 사망한 AMI 환자를 II군 266예(68.9 ± 12.5세, 남자 88.3%)로 분류하여, 각 군 간의 임상적 특징과 관상동맥 조영술 소견 및 1년 사망률 과 관련된 사망 예측인자를 분석하였다. 연구 방법 대한심장학회 50주년 기념 연구사업으로 진행되고 있는 KAMIR의 환자정보기록을 이용하였다. KAMIR 연구는 전남 대학병원 생명윤리위원회의 심의(CNUH 05-49)를 통과하여 모든 환자로부터 동의서를 취득한 후에 이루어졌다. 일반적 특성으로는 양 군(생존군, 사망군) 간의 연령, 성별, 체질량 지수(body mass index, BMI), Killip class, 흉통, 호흡곤란, 관 상동맥 질환 위험인자로 알려진 고혈압, 당뇨병, 고지혈증, 가족력, 과거력, 흡연력 등의 위험요인 및 염증반응 지표인 white blood cell, 혈당, ...

Effect of risk factor-tailored autonomy enhancement education in the first-time middle-aged patients undergoing percutaneous coronary intervention: a randomized controlled trial

“…According to the Korean registry data for acute myocardial infarction the smoking rate was 76.4% [ 28 ]. In addition, as a result of follow-up of smokers and non-smokers one year after PCI, continuing smoking significantly increased the mortality rate compared to quitting smoking [ 6 ], suggesting that smoking cessation education for middle-aged smokers after PCI is absolutely necessary.…”

“…Patients who experienced major adverse cardiac events within a year of PCI had a significantly higher prevalence of other chronic diseases, such as hypertension and diabetes [ 5 ]. Smoking was a major risk factor for major adverse cardiac events in this period [ 6 ]. Studies on the prognostic course of patients who underwent PCI showed that the mortality rate at recurrence was approximately four times higher than that at the onset [ 7 ].…”

Effect of Risk Factor-tailored Autonomy Enhancement Education in the First-time Middle-aged Patients undergoing Coronary Intervention: A randomized controlled trial

“…Typical risk factors for CAD include dyslipidemia, high blood pressure, diabetes, obesity, family history, and smoking, most of which are controllable through lifestyle modi cations [4]. Patients who experienced major adverse cardiac events within a year of PCI had a signi cantly higher prevalence of other chronic diseases, such as hypertension and diabetes [5]. Smoking was a major risk factor for major adverse cardiac events in this period [6].…”