Smoking status and mortality outcomes following percutaneous coronary intervention

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.

Identification of risk factors for falls in postmenopausal women: a systematic review and meta-analysis

“…Interestingly, smoking is a protective factor rather than a risk factor for falling in postmenopausal women. Smoking is extremely harmful to the human cardiac and respiratory systems, and the deterioration of cardiopulmonary function theoretically affects people's daily lives, including reducing activity [38,39], which may in turn reduce the risk of falling. In addition, smoking itself is a behavioural intermediary, and this behaviour does not directly reduce the risk of falling.…”

Effects of Smoking on Long-Term Clinical Outcomes and Lung Cancer in Patients with Acute Myocardial Infarction

“… 10) 11) 12) 13) 15) 27) Nevertheless, some studies have reported the “smoker's paradox.” 14) 16) These previous studies have investigated on shorter clinical outcomes compared with our results assessing 5-year clinical outcomes. 10) 11) 12) 13) Parasuraman et al 13) collected 12,656 patients with acute coronary syndrome following PCI to assess 30 day and 6 month mortality according to smoking status. Yadav et al 10) investigated the relationship between smoking and 5-year clinical outcomes from an individual patient pooled database, however only approximately 25% of the study population were diagnosed with AMI.…”

“… 8) 9) Previous studies have investigated the effects of smoking on clinical outcomes in patients with CAD. 10) 11) 12) 13) 14) 15) Although some studies have still reported smoker's paradox, 14) 16) numerous recent studies have shown similar or higher mortality in smokers compared to nonsmokers. 10) 11) 12) 13) 15) These discrepancies in study results are likely due to differences in study characteristics and covariate selection.…”

“… 10) 11) 12) 13) 14) 15) Although some studies have still reported smoker's paradox, 14) 16) numerous recent studies have shown similar or higher mortality in smokers compared to nonsmokers. 10) 11) 12) 13) 15) These discrepancies in study results are likely due to differences in study characteristics and covariate selection. It has been reported that smoker's paradox existed only in the thrombolysis era, 17) 18) but it still remains unclear whether smoker's paradox exists in the percutaneous coronary intervention (PCI) era.…”

The Impact of Smoking Status on the Long-Term Prognosis of Male Patients Underwent Percutaneous Coronary Intervention of Left Main Coronary Artery

“…However, most of the studies supporting this paradox originated in the thrombolytic and early PCI era. Few studies were based on the post-PCI era, which was recently supplemented by Parasuraman et al In a cohort study including 12,656 patients with non-elective PCI, smokers underwent PCI at an earlier age and were more likely to undergo PCI for acute coronary syndromes and had an increased 30-day mortality rate compared to non-smokers [16] .…”