According to an article published on Jan. 28 in the Journal of the American College of Cardiology, bupropion does not improve smoking cessation rates among patients hospitalized with acute myocardial infarction (AMI), and nearly two-thirds of patients treated with bupropion resumed smoking within one year of hospitalization.

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The multicenter, double-blind, placebo-controlled, randomized trial looked at 392 hospitalized patients who were randomized to nine weeks of bupropion or placebo. At 12-month follow-up, there was no statistically significant difference in the point-prevalent abstinence rates between bupropion and placebo (37.2 and 32 percent, respectively; p=0.33). There was also no difference in the incidence of major adverse cardiac events between bupropion- and placebo-treated patients (13  vs. 11 percent, respectively; p=0.64). Bupropion appeared to be well-tolerated in the immediate post-AMI phase and no major adverse events were reported.

The authors add that two-thirds of patients return to smoking within one year after AMI. They also found that "bupropion is well tolerated and seems to be safe in the immediate post-AMI period;" however, "bupropion is not effective for smoking cessation in patients post-AMI." "These results suggest that smoking remains a major issue in the patient population with AMI," they add.

In an accompanying editorial, Neal L. Benowitz, MD, University of California, San Francisco, and Judith Prochaska, PhD, MPH, Stanford University, Palo Alto, Calif., note that although bupropion did not improve smoking abstinence rates at one year, there was a substantial reduction in the average daily cigarette intake from 22.8 to 8.4 in both groups, suggesting a high level of motivation among post-AMI patients. The editorial also noted that smoking cessation among hospitalized patients is notoriously difficult, as these patients have often smoked for many years, and have continued to smoke even with the onset of chronic diseases and risk factors for acute cardiovascular events. They also point out that had the study reached its plan enrollment of 1,500 patients, the treatment differences would have achieved statistical significance.

"The standard of care for managing patients after myocardial infarction should include not only blood pressure and lipid management but also smoking cessation," write Benowitz and Prochaska. "Increasing quit rates will likely require a combination of counseling and personalized medications, with a chronic disease-management approach," they add.

Keywords: Myocardial Infarction, Follow-Up Studies, Chronic Disease, San Francisco, Standard of Care, Risk Factors, Blood Pressure, Universities, Hospitalization, Smoking Cessation, Smoking, United States

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