Predictors of Smoking Cessation After Percutaneous Coronary Revascularization

Predictors of Smoking Cessation After Percutaneous Coronary RevascularizationHasdai D, Garratt KN, Grill DE, Mathew V, Lerman A, Gau GT, Holmes DR Mayo Clin Proc 1998;73:205-209 Background. Cigarette smoking is common among patients undergoing percutaneous coronary revascularization. One might expect this event to motivate patients to quit smoking since studies suggest that the severity and signs of the coronary disease are related to successful smoking cessation. Methods. From 1979 through 1995, 1,169 smokers underwent percutaneous coronary revascularization at the Mayo Clinic and were followed for a maximum of 16 years with annual interviews. Patients were categorized into those who quit smoking immediately after the procedure (n = 435) and those who continued to smoke at some time during follow-up (n = 734). Independent predictors of smoking cessation were determined. Results. After percutaneous intervention, 63% of patients continued to smoke. Predictors of continued smoking included a greater pack-year smoking history, and the presence of ≥ 1 additional cardiac risk factor. Older patients and those with unstable angina at the time of presentation were more likely to quit. Conclusions. The majority of smokers after a percutaneous coronary intervention continue to smoke. Younger patients with more cardiac risk factors and a heavier smoking history, who would potentially benefit most from smoking cessation, are the least likely to quit. Comment. This study highlights the difficulty of smoking cessation among patients with coronary artery disease even at a time when one might expect them to be most receptive to change. The study methods might overstate the problem slightly since patients who quit smoking some time after the procedure were classified as persistent smokers. Nonetheless, emphasis on smoking cessation and the provision of effective counseling for all patients with coronary artery disease, especially those least likely to quit, is imperative.