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Published on: March 27, 2018
Smoking after coronary artery bypass: high three-year mortality
G M Lindsay1, E P Tolmie, W M Martin
1Cardiac Surgery, University of Glasgow, Glasgow, UK.
Insights
Persistent smoking negates the long-term survival benefits of coronary artery bypass grafting (CABG). Smokers face accelerated late mortality and increased myocardial ischemia after CABG surgery.
Area of Science:
- Cardiology
- Thoracic Surgery
- Public Health
Background:
- Coronary artery bypass grafting (CABG) improves prognosis and symptoms.
- Smoking's impact on long-term CABG survival remains unclear.
- This study investigates smoking's effect on survival and ischemia 7 years post-CABG.
Purpose of the Study:
- To determine the long-term influence of smoking on survival after CABG.
- To assess the impact of smoking on myocardial ischemia seven years post-CABG.
- To identify other risk factors affecting long-term outcomes after CABG.
Main Methods:
- 208 patients undergoing elective CABG were analyzed.
- 25% of patients were persistent smokers.
- Survival, symptoms, and thallium scans were assessed at 7 years.
Main Results:
- Smokers reported higher rates of angina and dyspnea.
- Smokers exhibited higher stress thallium and ischemia scores.
- Smoking was associated with increased mortality starting at 3 years post-CABG.
Conclusions:
- CABG offers significant benefits, but persistent smoking negates them.
- Smoking accelerates late mortality after CABG, exceeding previous reports.
- Symptoms and perfusion scans indicate higher ischemia in smokers post-CABG.
Background:
Coronary artery bypass grafting (CABG) is carried out for prognosis and symptomatic relief. Smoking is associated with increased postoperative complications, although its precise influence on long-term survival is unclear. We examined the influence of smoking and other risk factors on survival and myocardial ischaemia seven years after CABG.
Methods:
208 patients underwent elective CABG; 25 % were persistent smokers. 165 were alive at seven years. 128 (78 % of survivors) agreed to reexamination and 79 had thallium scans.
Results:
Angina and dyspnoea were reported by 52 % and 69 %, respectively, of survivors; these were associated with smoking ( P = 0.029 and 0.0 009) but with no other risk factors. Smokers had higher stress thallium scores ( P = 0.057) and ischaemia scores (10.6 +/- 6.5 vs. 6.8 +/- 6.0; P = 0.036); ejection fractions were equivalent. Obesity was prevalent and worsened in men. 33 patients (17 %) died during follow-up. Initially there was no survival difference between smokers and nonsmokers but as early as three years postoperation smoking was associated with an increased mortality ( P = 0.011; log-rank test).
Conclusions:
Patients experienced almost universal improvement with the operation. However, persistent smoking completely removed the prognostic benefits of CABG by accelerating late mortality which was higher than previously reported. Higher indices of ischaemia in smokers were suggested by symptoms and confirmed by perfusion scans.
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