La paradoja del tabaco en el síndrome coronario agudo. El abandono previo del hábito tabáquico como marcador de mejor pronóstico a corto plazo / The tobacco paradox in acute coronary syndrome. The prior cessation of smoking as a marker of a better short-term prognosis

Objetivo. La paradoja del tabaco es un fenómeno insuficientemente explicado en estudios previos. Este estudio analiza el papel pronóstico del tabaquismo previo o activo en pacientes con síndrome coronario agudo. Métodos. Obtuvimos los datos del registro ARIAM, entre 2001 y 2012. Se incluyó a 42.827 pacientes con síndrome coronario agudo (edad media 65±13 años, 26,4% mujeres). Se analizó la influencia del hábito tabáquico o de la condición de exfumador en la mortalidad mediante análisis multivariados. Resultados. Los fumadores eran más jóvenes, más frecuentemente hombres, tenían menos diabetes, hipertensión e historia previa de insuficiencia cardiaca, ictus, arritmia e insuficiencia renal, así como más frecuentemente elevación del ST e historia familiar. Los exfumadores presentaban más dislipidemia e historia de angina, infarto de miocardio, cardiopatía isquémica, vasculopatía periférica y broncopatía crónica. Fumadores y exfumadores desarrollaron menos frecuentemente shock cardiogénico (fumadores 4,2%, exfumadores 4,7% y no fumadores 6,9%, p<0,001). La mortalidad hospitalaria fue del 7,8% en los no fumadores, un 4,9% en los exfumadores y un 3,1% en los fumadores (p<0,001). En el análisis multivariado, el carácter fumador perdió su influencia en el pronóstico (-0,26%, p = 0,52 mediante cálculo de probabilidad inversa; y +0,26%, p=0,691 mediante análisis de propensión). Sin embargo, el carácter exfumador mostró una reducción significativa de la mortalidad en ambos test (-2,4% en el análisis de probabilidad inversa, p < 0,001, y -1,5% en el análisis de propensión, p = 0,005). Conclusiones. La paradoja del tabaco es un hallazgo que puede explicarse por otros factores pronósticos. El abandono del hábito tabáquico previo a un ingreso por síndrome coronario agudo se asocia a un mejor pronóstico (AU)

Objective. The tobacco paradox is a phenomenon insufficiently explained by previous studies. This study analyses the prognostic role of prior or active smoking in patients with acute coronary syndrome. Methods. We obtained data from the ARIAM registry, between 2001 and 2012. The study included 42,827 patients with acute coronary syndrome (mean age, 65±13 years; 26.4% women). The influence of smoking and that of being an ex-smoker on mortality was analysed using a multivariate analysis. Results. The smokers were younger, were more often men, had less diabetes, hypertension and prior history of heart failure, stroke, arrhythmia and renal failure and more frequently had ST-elevation and a family history of smoking. The ex-smokers had more dyslipidaemia and history of angina, myocardial infarction, ischemic heart disease, peripheral vasculopathy and chronic bronchial disease. Smokers and ex-smokers less frequently developed cardiogenic shock (smokers 4.2%, ex-smokers 4.7% and nonsmokers 6.9%, P<.001). Hospital mortality was 7.8% for the nonsmokers, 4.9% for the ex-smokers and 3.1% for the smokers (P<.001). In the multivariate analysis, the smoker factor lost its influence in the prognosis (-0.26%, p=.52 using an inverse probability calculation; and+0.26%, P=.691 using a propensity analysis). However, the exsmoker factor showed a significant reduction in mortality in both tests (-2.4% in the inverse probability analysis, P<.001; and -1.5% in the propensity analysis, P=.005). Conclusions. The tobacco paradox is a finding that could be explained by other prognostic factors. Smoking cessation prior to hospitalization for acute coronary syndrome is associated with a better prognosis (AU)

The tobacco paradox in acute coronary syndrome. The prior cessation of smoking as a marker of a better short-term prognosis. / La paradoja del tabaco en el síndrome coronario agudo. El abandono previo del hábito tabáquico como marcador de mejor pronóstico a corto plazo.

OBJECTIVE: The tobacco paradox is a phenomenon insufficiently explained by previous studies. This study analyses the prognostic role of prior or active smoking in patients with acute coronary syndrome. METHODS: We obtained data from the ARIAM registry, between 2001 and 2012. The study included 42,827 patients with acute coronary syndrome (mean age, 65±13 years; 26.4% women). The influence of smoking and that of being an ex-smoker on mortality was analysed using a multivariate analysis. RESULTS: The smokers were younger, were more often men, had less diabetes, hypertension and prior history of heart failure, stroke, arrhythmia and renal failure and more frequently had ST-elevation and a family history of smoking. The ex-smokers had more dyslipidaemia and history of angina, myocardial infarction, ischemic heart disease, peripheral vasculopathy and chronic bronchial disease. Smokers and ex-smokers less frequently developed cardiogenic shock (smokers 4.2%, ex-smokers 4.7% and nonsmokers 6.9%, P<.001). Hospital mortality was 7.8% for the nonsmokers, 4.9% for the ex-smokers and 3.1% for the smokers (P<.001). In the multivariate analysis, the smoker factor lost its influence in the prognosis (-0.26%, p=.52 using an inverse probability calculation; and+0.26%, P=.691 using a propensity analysis). However, the exsmoker factor showed a significant reduction in mortality in both tests (-2.4% in the inverse probability analysis, P<.001; and -1.5% in the propensity analysis, P=.005). CONCLUSIONS: The tobacco paradox is a finding that could be explained by other prognostic factors. Smoking cessation prior to hospitalization for acute coronary syndrome is associated with a better prognosis.

Poligrafía domiciliaria en pacientes con patología cardiovascular y sospecha de un SAHS / No disponible

OBJETIVOS: Validar la poligrafía domiciliaria en pacientes con comorbilidad vascular y sospecha de un síndrome de apneas hipopneas del sueño (SAHS) y determinar, en aquellos enfermos con cardiopatía isquémica, si el tratamiento con CPAP influye en el control de esta enfermedad. PACIENTES Y MÉTODOS: Fueron incluidos 42 enfermos (29 hombres y 13 mujeres, edad: 53 ± 7,8 años, IMC: 33 ± 5,2). Se les realizó poligrafía domiciliaria y polisomnografía convencional. Dieciséis pacientes con cardiopatía isquémica fueron evaluados tras el tratamiento con CPAP. El diagnóstico de SAHS se estableció ante un índice de apnea-hipopnea (IAH), en la polisomnografía> 5 y se indicó tratamiento con CPAP si el IAH fue > 15. RESULTADOS: Se observa una correlación y concordancia significativa (p < 0,01) entre la polisomnografía y poligrafía, en el IAH (36 ± 19,9 frente a 32 ± 17,4), r = 0,903 y CCI = 0,938, y en el índice de saturación (33 ± 23,5 frente a 35 ± 22,1), r = 0,896 y CCI = 0,948. Respecto a un IAH > 5 en la polisomnografía, la poligrafía obtiene un área bajo la curva ROC = 1 y para un IAH > 15el área bajo la curva ROC fue de 0,945. Tras el tratamiento con CPAP, los enfermos con cardiopatía isquémica acudieron menos frecuentemente al servicio de urgencias. CONCLUSIONES: La poligrafía domiciliaria es válida para el diagnóstico e indicación de tratamiento. En pacientes con cardiopatía isquémica, la CPAP mejora su control, descendiendo el número de consultas al servicio de urgencias (AU)

OOBJETIVES: To validate home poligraphy in patients with vascular comorbidity and suspicion of obstructive sleep apnea syndrome (OSAS), and to determine in patients with is chemicheart disease if treatment with CPAP influences in their control. PATIENTS AND METHODS: Forty-two patients were included (29 men and 13 women; Age: 53 ± 7.8 years; BMI: 33 ± 5.2)who were made home sleep study and conventional polysomnography. Sixteen patients with ischemic heart disease were evaluate dafter CPAP treatment. Diagnosis of OSAS was stablished when apnea-hypoapnea index (AHI) was > 5 in polysomnography and treatment with CPAP was indicated when AHI > 15. RESULTS: A significative correlation and concordance (p<0.01)were observed between the polysomnography and polygraphy in the AHI (36 ± 19.9 vs 32 ± 17.4), r = 0.903 and CCI = 0.938, and the desaturation index (33 ± 23.5 vs 35 ± 22.1), r = 0.896 and CCI = 0.948.When AHI >5 in polysomnography, the polygraphy obtained an are aunder the ROC curve = 1 and for IAH >15 the area under the ROC curve was 0.945. After CPAP treatment, patients with ischemic heart disease went less frequently to the hospital. CONCLUSIONS: Poligraphy is valid for diagnosis and treatment indication. Patients with ischemic heart disease, CPAP improves their control and reduces visits to the hospital (AU)