Smoking Is Associated With Adverse Clinical Outcomes in Patients Undergoing Revascularization With PCI or CABG
Key result
Smoking was an independent predictor of the composite endpoint of death, MI, or stroke (HR 1.8; 95% CI 1.3-2.5; P=0.001) in patients with complex CAD undergoing revascularization.
Why the study?
Some studies have suggested a smoker's paradox of neutral or favorable outcomes in smokers who developed CAD, especially MI.
Population
Patients with complex CAD undergoing revascularization with PCI or CABG in the SYNTAX trial
Comparison
Clinical outcomes compared according to smoking status
Design
Randomized controlled trial subanalysis
Follow-up
5-year follow-up
Authors
Discussion
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Member takes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
AJAjay J. KirtaneInterventional cardiologist, Columbia University Medical Center
“are sobering and emphasize that our efforts at smoking cessation for our patients with the most severe CAD need to be continuous, not myopically targeted only to the time of initial revascularization.”
“Abstinence from smoking may improve the outcomes achieved with coronary revascularization, and all patients undergoing PCI or CABG should be encouraged to stop smoking indefinitely before revascularization.”
PAPaul A. GurbelCardiologist, Sinai Hospital of Baltimore
“There is no question that there is a pharmacodynamic interaction of smoking with clopidogrel metabolism. Smoking enhances active metabolite generation and the resultant [pharmacodynamic] effect.”
Implication
Smoking was associated with worse post-revascularization outcomes; hypothesis-generating and requires RCTs before guiding cessation practice.
Key Points
- The study aims to determine the effect of smoking on clinical outcomes in patients undergoing revascularization procedures.
- Participants include patients undergoing PCI or CABG.
- Clinical outcomes assessed post-intervention with a focus on adverse events related to smoking.
- Analyses included adjustment for confounding factors.
- Smokers showed a higher rate of adverse clinical outcomes compared to non-smokers.
- Adjusted hazard ratio of adverse events for smokers was 1.8 (95% CI: 1.3-2.5, p=0.002).
- Significant differences in recovery rates and complications were observed.
Study Design
Type
RCT
PICO
P
Population
Patients with complex CAD undergoing revascularization with PCI or CABG in the SYNTAX trial, followed for 5 years to assess the impact of smoking status.
I
Intervention / Comparator
Smoking vs Non-smoking
O
Primary Outcome
composite endpoint of death/MI/stroke — HR 1.8 (1.3-2.5), p=0.001
Main Result
Hazard Ratio: 1.8 (95% CI 1.3–2.5)
p-value: p=0.001
Cite This Study
Zhang et al. (2015) conducted an RCT in complex coronary artery disease (CAD). Smoking vs. Non-smoking was evaluated on composite endpoint of death/MI/stroke (HR 1.8, 95% CI 1.3-2.5, p=0.001). Smoking was an independent predictor of the composite endpoint of death, MI, or stroke (HR 1.8; 95% CI 1.3-2.5; P=0.001) in patients with complex CAD undergoing revascularization.