Bupropion for Smoking Cessation in Patients Hospitalized With Acute Myocardial Infarction: A Randomized, Placebo-Controlled Trial
What is the safety and efficacy for 1-year smoking cessation rates of bupropion started in-hospital following an enzyme-positive acute myocardial infarction (AMI)?
ZESCA (Zyban as an Effective Smoking Cessation Aid for Patients Following an Acute Coronary Syndrome) was a multicenter, double-blind, randomized, placebo-controlled trial in which participants received bupropion or placebo for 9 weeks and were followed for 12 months. All participants received low-intensity behavioral counseling. The primary endpoint was point prevalence smoking cessation at 12 months assessed by 7-day recall and biochemical validation of expired carbon monoxide.
A total of 392 patients were randomized. Most patients were middle-aged men who had smoked for >3 decades and smoked approximately 1 pack/day. At 12 months, point prevalence abstinence rates were 37.2% in the bupropion group and 32.0% in the placebo group (p = 0.33). Major adverse cardiac event rates were similar (13.0% vs. 11.0%, respectively; p = 0.64). Among patients who returned for follow-up at 12 months, cigarette consumption decreased from a mean of 22.8 (standard deviation [SD] 10.5) at baseline to 4.7 (SD 7.3) at 12 months, with no difference between bupropion and placebo groups.
While well-tolerated and safe, bupropion does not appear to be effective for smoking cessation post-AMI.
The authors demonstrated that two thirds of patients with AMI returned to smoking by 12 months. Such findings are disappointing and contradict the intuition that patients following AMI would be highly motivated to quit and maintain 1-year smoking cessation rates. Of substance, many patients substantially reduced their daily cigarette consumption and likely are motivated to quit. Future efforts should target smoking-cessation and behavioral therapies that target long-standing nicotine addiction in this population to make more substantial, long-term, sustainable gains.
Keywords: Myocardial Infarction, Tobacco Use Disorder, Smoking Cessation, Smoking, Bupropion
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