Acute coronary syndrome: factors predicting smoking cessation

Few randomized controlled trials have examined the efficacy time of smoking cessation in hospitalized patients with acute coronary syndrome, either during hospitalization or after discharge.

To assess smoking cessation rates at 24 weeks among patients with acute coronary syndrome. Group A had begun nicotine replacement therapy during hospitalization, and Group B after discharge. We also determined factors predicting success.

We conducted a randomized controlled trial in the Cardiology Department and Smoking Cessation Service at University Hospital of Monastir, Tunisia from January 2015 to June 2016. Participants were randomly assigned to the above 2 groups. The endpoint assessment was smoking abstinence at 24 weeks, defined as self-reported abstinence in the past week, confirmed by measured exhaled carbon monoxide (CO) ≤ 8 ppm. We analysed data by intention to treat. We used a binary logistic regression model to determine factors predicting abstinence.

All participants were male and mean (standard deviation) age was 55 (11) years. At 24 weeks there was no significant difference in smoking cessation rate between the 2 groups: 54.5% [95% confidence interval (CI): 44.7-64.3%] in Group A and 45.5% (95% CI: 35.7-55.3%) in Group B (P = 0.81). High level of nicotine dependence [odds ratio (OR): 0.72; 95% CI: 0.54-0.96) and good compliance during follow-up (OR: 6.56; 95% CI: 2.07-20.78) were predictive factors for abstinence.

Smoking cessation rate after acute coronary syndrome was high regardless of the start date. Good compliance during follow-up was the key predictive factor for success.