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Cardiovascular medicine
Research
The prognostic significance of smoking cessation after acute coronary syndromes: an observational, multicentre study from the Melbourne interventional group registry
  1. Matias B Yudi1,2,
  2. Omar Farouque1,2,
  3. Nick Andrianopoulos3,
  4. Andrew E Ajani2,3,4,
  5. Katie Kalten1,
  6. Angela L Brennan3,
  7. Jeffrey Lefkovits3,4,
  8. Chin Hiew5,
  9. Ernesto Oqueli6,
  10. Christopher M Reid3,7,
  11. Stephen J Duffy3,8,
  12. David J Clark1,2
  13. on behalf of the Melbourne Interventional Group
  1. 1 Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
  2. 2 Department of Medicine, University of Melbourne, Melbourne, Australia
  3. 3 Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Australia
  4. 4 Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
  5. 5 Department of Cardiology, Barwon Health, Geelong, Australia
  6. 6 Department of Cardiology, Ballarat Base Hospital, Ballarat, Australia
  7. 7 School of Public Health, Curtin University, Perth, Western Australia
  8. 8 Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia
  1. Correspondence to Dr Matias B Yudi; matiasyudi{at}gmail.com

Abstract

Objective We aim to ascertain the prognostic significance of persistent smoking and smoking cessation after an acute coronary syndrome (ACS) in the era of percutaneous coronary intervention (PCI) and optimal secondary prevention pharmacotherapy.

Methods Consecutive patients from the Melbourne Interventional Group registry (2005–2013) who were alive at 30 days post-ACS presentation were included in our observational cohort study. Patients were divided into four categories based on their smoking status: non-smoker; ex-smoker (quit >1 month before ACS); recent quitter (smoker at presentation but quit by 30 days) and persistent smoker (smoker at presentation and at 30 days). The primary endpoint was survival ascertained through the Australian National Death Index linkage. A Cox-proportional hazards model was used to estimate the adjusted HR and 95% CI for survival.

Results Of the 9375 patients included, 2728 (29.1%) never smoked, 3712 (39.6%) were ex-smokers, 1612 (17.2%) were recent quitters and 1323 (14.1%) were persistent smokers. Cox-proportional hazard modelling revealed, compared with those who had never smoked, that persistent smoking (HR 1.78, 95% CI 1.36 to 2.32, p<0.001) was an independent predictor of increased hazard (mean follow-up 3.9±2.2 years) while being a recent quitter (HR 1.27, 95% CI 0.96 to 1.68, p=0.10) or an ex-smoker (HR 1.03, 95% CI 0.87 to 1.22, p=0.72) were not.

Conclusions In a contemporary cohort of patients with ACS, those who continued to smoke had an 80% risk of lower survival while those who quit had comparable survival to lifelong non-smokers. This underscores the importance of smoking cessation in secondary prevention despite the improvement in management of ACS with PCI and pharmacotherapy.

  • smoking
  • secondary prevention
  • acute coronary syndromes
  • long-term mortality
  • percutaneous coronary intervention

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2017-016874

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    Footnotes

    • Contributors MY, OF and DC developed the project concept and research hypothesis. MY and DC drafted the manuscript. NA, AB and CR provided statistical support. OF, AA, KK, JL, CH, EO and SD critically revised the manuscript for intellectual content. All authors read and approved the final document.

    • Funding The Melbourne Interventional Group acknowledge sunrestricted educational grant funding from: Abbott Vascular, Astra-Zeneca,Medtronic, MSD, Pfizer, Servier and The Medicines Company. These companies do not have access to the data and do not have the right to review manuscripts before publication. Professor SJD & Professor Reid’s work is funded by National Health and Medical Research Council of Australia Grants.

    • Competing interests None declared.

    • Ethics approval The study was approved by all individual hospitals involved in the Melbourne Interventional Group.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.