Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 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

Yao-Jun Zhang  1 , Javaid Iqbal  2 , David van Klaveren  3 , Carlos M Campos  4 , David R Holmes  5 , Arie Pieter Kappetein  4 , Marie-Claude Morice  6 , Adrian P Banning  7 , Ever D Grech  2 , Christos V Bourantas  4 , Yoshinobu Onuma  4 , Hector M Garcia-Garcia  4 , Michael J Mack  8 , Antonio Colombo  9 , Friedrich W Mohr  10 , Ewout W Steyerberg  3 , Patrick W Serruys  11
Affiliations
Free article
Randomized Controlled Trial

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

Yao-Jun Zhang et al. J Am Coll Cardiol. .
Free article

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.

PubMed Disclaimer

Comment in

  • Clearing the air on the "smoker's paradox".
    Kirtane AJ, Kelly CR. Kirtane AJ, et al. J Am Coll Cardiol. 2015 Mar 24;65(11):1116-8. doi: 10.1016/j.jacc.2015.01.012. J Am Coll Cardiol. 2015. PMID: 25790883 No abstract available.

Publication types

Associated data