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Smoking and CV Outcomes After PCI
Quick Takes
- Among quitters who stopped smoking after PCI, those with a cumulative smoking exposure of <20 pack-years had a comparable rate of MACCE with that of persistent nonsmokers.
- Cumulative pack-years of smoking history was positively associated with increased risk for future MACCE, such that those with a pack-year history of ≥30 had a similar MACCE risk to persistent smokers.
- For persistent smokers, the adjusted HR of future MACCE was 1.223 (95% CI, 1.126-1.328) compared with persistent nonsmokers.
Study Questions:
Does smoking cessation after percutaneous coronary intervention (PCI) reduce risk for cardiovascular (CV) outcomes?
Methods:
Data from the Korean National Health Insurance System were used for the present analysis. Patients undergoing PCI between 2009 and 2016 were classified by smoking status as nonsmokers, ex-smokers, or current smoking, determined at the first health check-up within 1-year post-PCI. The primary composite outcome of major adverse CV and cerebrovascular events (MACCE) included all-cause death, myocardial infarction, coronary revascularization, and stroke.
Results:
A total of 74,471 patients were included, mean age 62.5 ± 10.6 years, and 56,423 patients (75.8%) were men. Nonsmokers were older, were more likely to be female, and had a higher prevalence of hypertension. Ex-smokers had a lower prevalence of diabetes mellitus and were less likely to have a lower income. Current smokers were younger, had a higher prevalence of diabetes mellitus, and were more likely to have lower incomes. During the 4 years of follow-up, current smokers had an increased risk for MACCE compared to nonsmokers, with an adjusted hazard ratio (aHR) of 1.198 (95% confidence interval [Cl], 1.137-1.263), while ex-smokers had a comparable rate to nonsmokers (aHR, 1.036; 95% Cl, 0.992-1.081).
Among the 31,887 patients with both pre- and post-PCI health check-up data, the effects of smoking cessation were assessed. Persistent nonsmokers were used as the reference group. For those who stopped smoking after PCI and had a cumulative smoking exposure of <20 pack-years, the risk for future MACCE was similar to that of nonsmokers (aHR, 1.182; 95% CI, 0.971-1.438 for <10 packers and aHR, 1.114; 95% CI, 0.963-1.290 for 10-20 pack-years). For patients who smoked ≥20 pack-years, the risk for future MACCE increased with increasing pack-years from aHR, 1.206 (95% CI, 1.054-1.380) for those with 20-30 pack-years to aHR, 1.227 (95% CI, 1.113-1.352) for those with ≥30 pack-years. For persistent smokers, the aHR of future MACCE was 1.223 (95% CI, 1.126-1.328) compared with persistent nonsmokers.
Conclusions:
The authors conclude that smoking is associated with a higher risk of adverse outcomes in patients undergoing PCI. Quitters after PCI with <20 pack-years were associated with a risk comparable with that of nonsmokers.
Perspective:
These data support smoking cessation after PCI, particularly for those who have lower pack-year smoking histories.
Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Prevention, Smoking
Keywords: Percutaneous Coronary Intervention, Smoking, Smoking Cessation
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