Effect of Smoking Status on Clinical Outcome and Efficacy of Clopidogrel in Acute Coronary Syndrome
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- Kodaira Masaki
- Department of Cardiology, Ashikaga Red Cross Hospital
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- Miyata Hiroaki
- Department Healthcare Quality Assessment, The University of Tokyo
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- Numasawa Yohei
- Department of Cardiology, Ashikaga Red Cross Hospital
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- Ueda Ikuko
- Department of Cardiology, Keio University School of Medicine
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- Maekawa Yuichiro
- Department of Cardiology, Keio University School of Medicine
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- Sueyoshi Koichiro
- Department of Cardiology, Kawasaki Municipal Hospital
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- Ishikawa Shiro
- Department of Cardiology, Saitama City Hospital
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- Ohki Takahiro
- Department of Cardiology, Tokyo Dental University
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- Negishi Kouji
- Department of Cardiology, Yokohama Municipal Hospital
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- Fukuda Keiichi
- Department of Cardiology, Keio University School of Medicine
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- Kohsaka Shun
- Department of Cardiology, Keio University School of Medicine
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説明
Background:The “smoker’s paradox” is an otherwise unexplained phenomenon in which the mortality of smokers after acute myocardial infarction is reduced, contrary to expectations. It has been suggested that an association with antiplatelet agents exists, but the true mechanism remains largely unidentified.Methods and Results:The analysis included 6,195 consecutive patients who underwent percutaneous coronary intervention (PCI) for acute coronary syndrome, registered in the Japanese multicenter PCI registry. Smokers were significantly younger and had less comorbidity than non-smokers. Unadjusted in-hospital mortality rate, general complication rate, and bleeding complication rate were lower in smokers than in non-smokers. After adjustment, the trend persisted and smoking was not associated with overall mortality (odds ratio [OR], 0.90; 95% confidence interval [CI]: 0.61–1.34; P=0.62), and was associated with lower overall (P=0.032) and bleeding complication events (P=0.040). Clopidogrel effectively reduced the occurrence of in-hospital complications and major adverse cardiac events in smokers compared with non-smokers (OR, 0.55; 95% CI: 0.53–0.98 vs. OR, 1.20; 95% CI: 0.87–1.67; and OR, 0.37; 95% CI: 0.20–0.70 vs. OR, 1.48; 95% CI: 0.90–2.43, respectively).Conclusions:The smoker’s paradox was largely explained by confounding factors related to the lower risk profile of smokers, and they benefited from a positive modification of the efficacy of clopidogrel. (Circ J 2016; 80: 1590–1599)
収録刊行物
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- Circulation Journal
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Circulation Journal 80 (7), 1590-1599, 2016
一般社団法人 日本循環器学会
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詳細情報 詳細情報について
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- CRID
- 1390282680085409792
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- NII論文ID
- 130005158904
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- NII書誌ID
- AA11591968
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- ISSN
- 13474820
- 13469843
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- NDL書誌ID
- 027439049
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- PubMed
- 27245240
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- 本文言語コード
- en
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- データソース種別
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- JaLC
- NDL
- Crossref
- PubMed
- CiNii Articles
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