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Published on: March 27, 2018
Impact of Myocardial Revascularization Method on Smoking Cessation: Coronary Artery Bypass Grafting versus
Ricardo das Neves1, Greicy Kelly Avila2, Fernando de Barros Oliveira1
1Cardiovascular Surgery Department of Hospital Santa Lucinda, Sorocaba, São Paulo, Brazil.
Insights
Major heart surgery, specifically coronary artery bypass grafting (CABG), is more effective for smoking cessation than percutaneous coronary intervention (PCI) in the short term. Long-term success depends on nicotine dependence and passive smoking.
Area of Science:
- Cardiology
- Public Health
- Behavioral Science
Background:
- Smoking is a major risk factor for heart disease and sudden death.
- Major health events can prompt changes in patient behavior.
- Myocardial revascularization methods may influence smoking cessation rates.
Purpose of the Study:
- To compare smoking cessation rates and relapse after coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI).
Main Methods:
- Smokers undergoing myocardial revascularization were divided into CABG and PCI groups.
- Interviews were conducted post-discharge with a 12-month follow-up.
- Exclusion criteria included prior cessation, combined procedures, readmission, death, or emergency procedures.
Main Results:
- Smoking relapse was significantly lower in the CABG group at 30 and 180 days post-discharge.
- No significant difference in relapse rates was observed between CABG and PCI groups at 360 days.
- High nicotine dependence and passive smoking predicted long-term relapse.
Conclusions:
- Major surgical procedures like CABG may offer psychological benefits conducive to smoking cessation.
- These findings highlight opportunities for targeted smoking cessation counseling post-myocardial revascularization.
Introduction:
Smoking is a serious public health issue, being a precursor of heart disease and a predictor of sudden death due to myocardial ischemia. Major events in the patient's health can lead to radical changes in habits and the choice for different myocardial revascularization methods might differently impact smoking cessation and relapse.
Objective:
To study the rate and perpetuation of smoking cessation after myocardial revascularization comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI).
Methods:
Smokers submitted to myocardial revascularization were divided into CABG and PCI groups. The research was conducted through interviews at the Hospital Santa Lucinda outpatient clinic. Patients with smoking cessation longer than 90 days before hospital admission, combined procedures, hospital readmission before 360 days after discharge, cases of death at any time, and emergency procedures were excluded from the study. The start of the smoking cessation period was determined as just after hospital discharge, with a follow-up of 12 months.
Results:
The proportion of patients reporting smoking relapse was significantly lower in the CABG than in the PCI group at 30 (11.1% vs. 20.8%; P=0.039) and at 180 days (23.1% vs. 41.5%; P=0.002), but no differences were observed between the two groups at 360 days after hospital discharge (51.9% vs. 54.1%; P=0.719). High levels of nicotine dependence and passive smoking showed to be important predictors of smoking relapse in the long-term.
Conclusion:
The occurrence of a major surgical procedure seems to have beneficial psychological effects, representing an interesting setting for smoking cessation counseling to have higher chances of success.
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