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Inicio Journal of Healthcare Quality Research Intervención antitabaco en fase aguda del síndrome coronario agudo: ¿existe b...
Journal Information
Vol. 38. Issue 2.
Pages 105-111 (March - April 2023)
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Vol. 38. Issue 2.
Pages 105-111 (March - April 2023)
ORIGINAL
Intervención antitabaco en fase aguda del síndrome coronario agudo: ¿existe beneficio adicional en pacientes incluidos en un programa de rehabilitación cardiaca?
Anti-smoking intervention in the acute phase of acute coronary syndrome: Is there additional benefit in patients included in a cardiac rehabilitation program?
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J. Jimeno Sáncheza,
Corresponding author
javierjimeno1@gmail.com

Autor para correspondencia.
, M.C. Chabbar Boudeta,b, P. Morlanes Graciac, S. Laita Monreald, C.R. López Peralesa, G. Cukob, C. Albarrán Martínb,c, F. Garza Benitob,d
a Hospital Universitario Miguel Servet, Zaragoza, España
b Hospital Nuestra Señora de Gracia, Zaragoza, España
c Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
d Hospital Royo Villanova, Zaragoza, España
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Abstract
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Resumen
Introducción

La deshabituación tabáquica supone un reto en prevención secundaria. Los programas de rehabilitación cardiaca (PRC) incrementan los resultados de abstinencia. El objetivo fue valorar si una intervención antitabaco precoz (IAP) mejora la tasa de abstinencia obtenida tras un PRC.

Métodos

Ensayo clínico multicéntrico que incluyó pacientes fumadores ingresados por síndrome coronario agudo (SCA) revascularizados percutáneamente, aleatorizados 1:1 a recibir o no IAP desde el primer día de ingreso. Al alta ambos grupos fueron remitidos al PRC. Se realizaron controles periódicos de cooximetría para verificar abstinencia.

Resultados

Se incluyeron 72 pacientes, 58 hombres (80,5%), edad media 53 ± 8,1 años. Ingresaron por SCA con elevación de ST 42 (58%) y sin elevación de ST 30 (42%). Fumaban de media 22 ± 11,3 cigarrillos/día. Cumplimentaron el test de Richmond (8,8 ± 1,3) y Fagestrom (5,69 ± 2,1). Se aleatorizó a IAP a 36 pacientes (50%), sin diferencias en las características basales de ambos grupos. La tasa de abandono en el momento de inclusión en PRC fue mayor en el grupo de IAP (69 vs. 44%; p = 0,034; 0R 2,84), sin alcanzar la significación estadística al alta del PRC (58 vs. 50%; p = 0,478; OR 1,4) ni a los 12 meses (58 vs. 44%; p = 0,24; OR 1,75). Se produjeron 12 pérdidas, consideradas fumadores.

Conclusiones

En pacientes con SCA revascularizados percutáneamente, una IAP durante el ingreso mejora significativamente la tasa de abandono en el momento de inclusión en el PRC. Sin embargo, parte de estos efectos beneficiosos parecen neutralizarse con el tiempo perdiendo significación estadística respecto al grupo control.

Palabras clave:
Tabaco
Prevención secundaria
Terapia cognitivo-conductual
Síndrome coronario agudo
Rehabilitación cardiaca
Abstract
Background

Smoking is a challenge in secondary prevention after acute coronary syndrome (ACS). The objective was to assess whether the early anti-smoking intervention (ASI), in the acute hospitalization phase, improves the abstinence rate obtained during a cardiac rehabilitation program (CRP).

Methods

Multicenter clinical trial in which smoker patients admitted for ACS were randomized 1:1 to receive or not ASI from the first day of admission. Upon discharge, both groups were referred to the CRP, performing abstinence controls using co-oximetry. Patients lost were considered smokers.

Results

72 patients were included, 58 men (80.5%), mean age 53 ± 8.1 years. They were admitted for ST elevation myocardial infarction 42 (58%), non-ST elevation myocardial infarction 29 (40%) and unstable angina 1 (1.3%). They smoked an average of 22 ± 11.3 cigarettes/day (pack-year index 37 ± 20). They completed the Richmond test (8.8 ± 1.3) and Fagestrom (5.69 ± 2.1). 36 patients (50%) were randomized to ASI, with no differences in the baseline characteristics of both groups. The dropout rate at the time of inclusion in CRP was higher in the ASI group (69 vs. 44%; p 0.034; OR 2.84), without statistical significance at discharge from the CRP (58 vs. 50%; p 0.478; OR 1.4) or at 12 months (58 vs. 44%; p 0.24; OR 1.75).

Conclusions

The ASI during admission significantly improves the smoking cessation rate at the time of inclusion in the CRP. Part of these beneficial effects are reduced in the follow-up losing statistical significance with respect to the control group.

Keywords:
Smoking
Smoking cessation
Secondary prevention
Cognitive behavioural therapy
Acute coronary syndrome
Cardiovascular disease
Cardiac rehabilitation

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