Smoking status and mortality outcomes following percutaneous coronary intervention

Sathish Parasuraman; Azfar G Zaman; Mohaned Egred; Alan Bagnall; Paul A Broadhurst; Javed Ahmed; Richard Edwards; Raj Das; Deepak Garg; Ian Purcell; Awsan Noman

doi:10.1177/2047487320902325

Smoking status and mortality outcomes following percutaneous coronary intervention

Eur J Prev Cardiol. 2021 Sep 20;28(11):1222-1228. doi: 10.1177/2047487320902325.

Authors

Affiliations

¹ Musgrove Park Hospital, Taunton, UK.
² Freeman Hospital, Newcastle upon Tyne, UK.
³ Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK.

PMID: 33611373
DOI: 10.1177/2047487320902325

Abstract

Objective: The aim of this study was to assess the impact of smoking on short (30-day) and intermediate (30-day to 6-month) mortality following percutaneous coronary intervention (PCI).

Background: The effect of smoking on mortality post-PCI is lacking in the modern PCI era.

Methods: This was a retrospective analysis of prospectively collected data comparing short- and intermediate-term mortality amongst smokers, ex-smokers and non-smokers.

Results: The study cohort consisted of 12,656 patients: never-smokers (n = 4288), ex-smokers (n = 4806) and current smokers (n = 3562). The mean age (±standard deviation) was 57 (±11) years in current smokers compared with 67 (±11) in ex-smokers and 67 (±12) in never-smokers; p < 0.0001. PCI was performed for acute coronary syndrome (ACS) in 84.1% of current smokers, 57% of ex-smokers and 62.9% in never-smokers; p < 0.0001. In a logistic regression model, the adjusted odds ratios (95% confidence intervals (CIs)) for 30-day mortality were 1.60 (1.10-2.32) in current smokers and 0.98 (0.70-1.38) in ex-smokers compared with never-smokers. In the Cox proportional hazard model, the adjusted hazard ratios (95% CI) for mortality between 30 days and 6 months were 1.03 (0.65-1.65) in current smokers and 1.19 (0.84-1.67) in ex-smokers compared with never-smokers.

Conclusion: This large observational study of non-selected patients demonstrates that ex-smokers and never-smokers are of similar age at first presentation to PCI, and there is no short- or intermediate-term mortality difference between them following PCI. Current smokers undergo PCI at a younger age, more often for ACS, and have higher short-term mortality. These findings underscore the public message on the benefits of smoking cessation and the harmful effects of smoking.

Keywords: PCI mortality; PCI outcome; Smoking; heart attack and smoking; percutaneous coronary intervention; smokers’ outcome; smoking and PCI; smoking mortality; stents in smokers.