Background Cigarette smoking is known to be deleterious to patientswith coronary artery disease, but the effect of smoking on theclinical outcome of percutaneous coronary revascularizationis unknown.
Methods Patients who had undergone successful percutaneous coronaryrevascularization at the Mayo Clinic between 1979 and 1995 weredivided into nonsmokers (n = 2009), former smokers (those whohad stopped smoking before the procedure, n = 2259), quitters(those who stopped smoking after the procedure, n = 435), andpersistent smokers (those who smoked before and after the procedure,n = 734).
Results The maximal follow-up was 16 years (mean [±SD],4.5±3.4). The nonsmokers and former smokers had similarbase-line characteristics and outcomes. The quitters and persistentsmokers were younger than the nonsmokers and former smokersand had more favorable clinical and angiographic characteristics.In analyses adjusted for confounding base-line characteristics,the persistent smokers had a greater relative risk of death(1.76 [95 percent confidence interval, 1.37 to 2.26]) and ofQ-wave infarction (2.08 [95 percent confidence interval, 1.16to 3.72]) than the nonsmokers. The quitters and persistent smokerswere less likely than the nonsmokers to undergo additional percutaneouscoronary procedures (relative risk, 0.80 [95 percent confidenceinterval, 0.64 to 0.98] and 0.67 [95 percent confidence interval,0.56 to 0.81], respectively) or coronary bypass surgery (relativerisk, 0.72 [95 percent confidence interval, 0.54 to 0.95] and0.68 [95 percent confidence interval, 0.54 to 0.86], respectively).The persistent smokers were also at greater risk for death thanthe quitters (relative risk, 1.44 [95 percent confidence interval,1.02 to 2.11]).
Conclusions Patients who continued to smoke after successfulpercutaneous coronary revascularization were at greater riskfor Q-wave infarction and death than nonsmokers. The cessationof smoking either before or after percutaneous revascularizationwas beneficial. Patients undergoing percutaneous revascularizationshould be encouraged to stop smoking.
Source Information
From the Division of Internal Medicine and Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, Rochester, Minn.
Address reprint requests to Dr. Holmes at the Division of Internal Medicine and Cardiovascular Diseases, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905.
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