Coronary artery disease (CAD) patients who continue to smoke after undergoing bypass surgery or angioplasty were twice as likely to have negative long-term outcomes than non-smokers and patients who quit, according to a study published March 16 in the Journal of the American College of Cardiology.

Although cigarette smoking is a widely known risk factor in the development of CAD, some previous studies have suggested that smokers with CAD had similar or even favorable outcomes as compared to non-smokers.  In the SYNTAX trial, lead researcher Javaid Iqbal, MRCP, PhD, et al., set out to evaluate these claims using a randomized trial and examined smoking status in CAD patients at six months and one, three and five year follow-up. A total of 1,793 severe CAD patients who had undergone either angioplasty or bypass surgery were included in the study and monitored for clinical outcomes.

A total of 17.9 percent of the trial’s participants changed their smoking status during the five years the study was conducted.  At the outset of the study, 20 percent of patients were smokers; of that number, 60 percent of people quit smoking after undergoing either bypass surgery or angioplasty.  Results of the SYNTAX study disproved the theory of a “smokers paradox” by demonstrating that CAD patients who continued to smoke after treatment, were 50 percent more likely to have negative clinical outcomes as compared to non-smokers. 

“Our data has unequivocally shown that smoking has adverse outcomes after revascularization,” said Iqbal. “It is strongly advisable for patients with heart disease to quit smoking, especially those undergoing angioplasty or bypass, and clinicians should be asking about smoking status at every visit.” 

In a corresponding editorial comment, Ajay Kirtane, MD, SM, FACC, and Christopher Kelly, MD, reiterated the importance of the SYNTAX study results which disproved of the idea of a “smokers paradox,” and emphasized that smoking was a greater risk factor than even a 10-year age increase.  

“These findings are sobering and emphasize that our efforts at smoking cessation for our patients with the most severe CAD need to be continuous, not myopically targeted only to the time of initial revascularization,” said Kirtane. “As clinicians treating individual patients, it is critical for us to put these data in perspective, continuing to focus assiduously on smoking cessation with all patients, and remembering that relapses are common, even in high-risk patients who have undergone multivessel coronary revascularization.”

Keywords: Angioplasty, Cholangiopancreatography, Magnetic Resonance, Coronary Artery Disease, Coronary Disease, Follow-Up Studies, Heart Diseases, Recurrence, Research Personnel, Risk Factors, Smoke, Smoking, Smoking Cessation, Tobacco

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