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Smoking may be more harmful to vasospastic angina patients who take antiplatelet agents due to the interaction: Results of Korean prospective multi-center cohort

Authors
 Seong-Sik Cho  ;  Sang-Ho Jo  ;  Hyun-Jin Kim  ;  Min-Ho Lee  ;  Won-Woo Seo  ;  Hack-Lyoung Kim  ;  Kwan Yong Lee  ;  Tae-Hyun Yang  ;  Sung-Ho Her  ;  Seung Hwan Han  ;  Byoung-Kwon Lee  ;  Keun-Ho Park  ;  Seung-Woon Rha  ;  Hyeon-Cheol Gwon  ;  Dong-Ju Choi  ;  Sang Hong Ba다 
Citation
 PLOS ONE, Vol.16(4) : e0248286, 2021-04 
Journal Title
PLOS ONE
Issue Date
2021-04
MeSH
Acute Coronary Syndrome / etiology ; Adult ; Aged ; Angina Pectoris / complications* ; Arrhythmias, Cardiac / etiology ; Coronary Vasospasm / complications* ; Death ; Female ; Humans ; Male ; Middle Aged ; Platelet Aggregation Inhibitors / adverse effects* ; Prospective Studies ; Republic of Korea / epidemiology ; Smoking / adverse effects*
Abstract
Background: The interaction between smoking and the use of antiplatelet agents on the prognosis of vasospastic angina (VA) is rarely investigated.

Methods: VA-Korea is a nation-wide multi-center registry with prospective design (n = 1812). The primary endpoint was the composite occurrence of acute coronary syndrome (ACS), symptomatic arrhythmia, and cardiac death. Log-rank test and Cox proportional hazard model were for statistical analysis. Also, we conducted interaction analysis in both additive and multiplicative scales between smoking and antiplatelet agents among VA patients. For additive scale interaction, relative excess risk due to interaction (RERI) was calculated and for multiplicative scale interaction, the ratio of hazard ratio (HR) was calculated. All statistical analysis conducted by Stata Ver 16.1.

Results: Patients who were smoking and using antiplatelet agents had the highest incidence rate in the primary composite outcome. The incidence rate was 3.49 per 1,000 person-month (95% CI: 2.30-5.30, log-rank test for primary outcome p = 0.017) and HR of smoking and using antiplatelet agents was 1.66 (95%CI: 0.98-2.81). The adjusted RERI of smoking and using antiplatelet agents was 1.10 (p = 0.009), and the adjusted ratio of HR of smoking and using antiplatelet agents was 3.32 (p = 0.019). The current study observed the interaction between smoking and using antiplatelet agents in both additive and multiplicative scales.

Conclusions: Smoking was associated with higher rates of unfavorable clinical outcomes among VA patients taking antiplatelet agents. This suggested that VA patients, especially those using antiplatelet agents should quit smoking.
Files in This Item:
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DOI
10.1371/journal.pone.0248386
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Lee, Byoung Kwon(이병권) ORCID logo https://orcid.org/0000-0001-9259-2776
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/186811
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