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J Am Coll Cardiol. 2015 Mar 24;65(11):1107-15. doi: 10.1016/j.jacc.2015.01.014.

Smoking is associated with adverse clinical outcomes in patients undergoing revascularization with PCI or CABG: the SYNTAX trial at 5-year follow-up.

Author information

1
Thoraxcenter, Erasmus Medical Centre, Rotterdam, the Netherlands; Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
2
Sheffield Teaching Hospitals and the University of Sheffield, Sheffield, United Kingdom.
3
Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands.
4
Thoraxcenter, Erasmus Medical Centre, Rotterdam, the Netherlands.
5
Mayo Clinic, Rochester, Minnesota.
6
Institut Jacques Cartier, Massy, France.
7
Oxford University Hospitals, Oxford, United Kingdom.
8
The Heart Hospital, Plano, Texas.
9
San Raffaele Scientific Institute, Milan, Italy.
10
Herzzentrum Universität Leipzig, Leipzig, Germany.
11
Thoraxcenter, Erasmus Medical Centre, Rotterdam, the Netherlands; International Centre for Circulatory Health, Imperial College London, London, United Kingdom. Electronic address: patrick.w.j.c.serruys@gmail.com.

Abstract

BACKGROUND:

Cigarette smoking is a well-known risk factor for development of coronary artery disease (CAD). However, some studies have suggested a "smoker's paradox," meaning neutral or favorable outcomes in smokers who have developed CAD, especially myocardial infarction (MI).

OBJECTIVES:

The study aimed to examine the association of smoking status with clinical outcomes in the randomized controlled SYNTAX (SYNergy Between PCI With TAXUS and Cardiac Surgery) trial at 5-year follow-up.

METHODS:

Detailed smoking history was collected at baseline, 6-month, 1-year, 3-year, and 5-year follow-up. The composite endpoints included death/MI/stroke (primary endpoint) plus major adverse cardiac and cerebrovascular events (MACCE) (combination of death/MI/stroke and target lesion revascularization) according to patient smoking status. The comparison of 5-year clinical outcomes between the groups according to smoking status was performed with Cox regression using smoking status at baseline or smoking as a time-dependent covariate.

RESULTS:

A sizeable proportion (n = 322, 17.9%) of patients had changing smoking status during 5-year follow-up. One in 5 patients with complex CAD was smoking at baseline. However, 60% stopped after revascularization while others continued to smoke. Smokers had worse clinical outcomes due to a higher incidence of recurrent MI in both revascularization arms. Smoking was an independent predictor of the composite endpoint of death/MI/stroke (hazard ratio [HR]: 1.8; 95% confidence interval [CI]: 1.3 to 2.5; p = 0.001) and MACCE (HR: 1.4; 95% CI: 1.1 to 1.7; p = 0.02).

CONCLUSIONS:

Smoking is associated with poor clinical outcomes after revascularization in patients with complex CAD. This places further emphasis on efforts at smoking cessation to improve revascularization benefits. (SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries; NCT00114972).

KEYWORDS:

cessation; major adverse cardiac and cerebrovascular event(s); smoker’s paradox

Comment in

PMID:
25790882
DOI:
10.1016/j.jacc.2015.01.014
[Indexed for MEDLINE]
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