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Observational Study
. 2017 Oct 6;7(10):e016874.
doi: 10.1136/bmjopen-2017-016874.

The prognostic significance of smoking cessation after acute coronary syndromes: an observational, multicentre study from the Melbourne interventional group registry

Matias B Yudi  1   2 , Omar Farouque  1   2 , Nick Andrianopoulos  3 , Andrew E Ajani  2   3   4 , Katie Kalten  1 , Angela L Brennan  3 , Jeffrey Lefkovits  3   4 , Chin Hiew  5 , Ernesto Oqueli  6 , Christopher M Reid  3   7 , Stephen J Duffy  3   8 , David J Clark  1   2 ; Melbourne Interventional Group
Affiliations
Observational Study

The prognostic significance of smoking cessation after acute coronary syndromes: an observational, multicentre study from the Melbourne interventional group registry

Matias B Yudi et al. BMJ Open. .

Abstract

Objective: We aim to ascertain the prognostic significance of persistent smoking and smoking cessation after an acute coronary syndrome (ACS) in the era of percutaneous coronary intervention (PCI) and optimal secondary prevention pharmacotherapy.

Methods: Consecutive patients from the Melbourne Interventional Group registry (2005-2013) who were alive at 30 days post-ACS presentation were included in our observational cohort study. Patients were divided into four categories based on their smoking status: non-smoker; ex-smoker (quit >1 month before ACS); recent quitter (smoker at presentation but quit by 30 days) and persistent smoker (smoker at presentation and at 30 days). The primary endpoint was survival ascertained through the Australian National Death Index linkage. A Cox-proportional hazards model was used to estimate the adjusted HR and 95% CI for survival.

Results: Of the 9375 patients included, 2728 (29.1%) never smoked, 3712 (39.6%) were ex-smokers, 1612 (17.2%) were recent quitters and 1323 (14.1%) were persistent smokers. Cox-proportional hazard modelling revealed, compared with those who had never smoked, that persistent smoking (HR 1.78, 95% CI 1.36 to 2.32, p<0.001) was an independent predictor of increased hazard (mean follow-up 3.9±2.2 years) while being a recent quitter (HR 1.27, 95% CI 0.96 to 1.68, p=0.10) or an ex-smoker (HR 1.03, 95% CI 0.87 to 1.22, p=0.72) were not.

Conclusions: In a contemporary cohort of patients with ACS, those who continued to smoke had an 80% risk of lower survival while those who quit had comparable survival to lifelong non-smokers. This underscores the importance of smoking cessation in secondary prevention despite the improvement in management of ACS with PCI and pharmacotherapy.

Keywords: acute coronary syndromes; long-term mortality; percutaneous coronary intervention; secondary prevention; smoking.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Smokers at baseline, 30 days and 12 months. *Includes only those patients alive at 12 months. Recent quitters were smokers at baseline but had quit by 30 days. Persistent smokers were smokers at baseline and were still smoking 30 days and 12 months post acute coronary syndrome. Relapsed smokers were smoking at 12 months although they temporarily quit at 30 days.
Figure 2
Figure 2
Trends in smoking status in acute coronary syndrome survivors at 30 days.
Figure 3
Figure 3
Cox proportional hazard regression survival curve.
See this image and copyright information in PMC

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References

    1. Ezzati M, Henley SJ, Thun MJ, et al. . Role of smoking in global and regional cardiovascular mortality. Circulation 2005;112:489–97. 10.1161/CIRCULATIONAHA.104.521708 - DOI - PubMed
    1. Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA 2003;290:86–97. 10.1001/jama.290.1.86 - DOI - PubMed
    1. Wilson K, Gibson N, Willan A, et al. . Effect of smoking cessation on mortality after myocardial infarction: meta-analysis of cohort studies. Arch Intern Med 2000;160:939–44. - PubMed
    1. Van Berkel TF, Boersma H, Roos-Hesselink JW, et al. . Impact of smoking cessation and smoking interventions in patients with coronary heart disease. Eur Heart J 1999;20:1773–82. 10.1053/euhj.1999.1658 - DOI - PubMed
    1. Smith SC, Benjamin EJ, Bonow RO, et al. . AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation endorsed by the World Heart Federation and the Preventive Cardiovascular Nurses Association. J Am Coll Cardiol 2011;58:2432–46. 10.1016/j.jacc.2011.10.824 - DOI - PubMed

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