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?


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.


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.


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.


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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