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Association between smoking and in-hospital mortality in patients with left ventricular dysfunction undergoing
Hanwei Tang1, Jianfeng Hou1, Kai Chen1
1Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A Beilishi Rd, Xi Cheng District, Beijing, 100037, People's Republic of China.
Insights
Current smokers undergoing coronary artery bypass graft surgery showed lower in-hospital mortality than non-smokers, a finding termed the "smoker
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Public Health
Background:
- Limited data exists on smoking's impact on in-hospital outcomes for patients with left ventricular dysfunction undergoing coronary artery bypass graft (CABG) surgery.
- This study investigates the influence of smoking on these specific patient outcomes.
Purpose of the Study:
- To determine the effect of smoking on in-hospital mortality and other clinical endpoints in patients with left ventricular dysfunction undergoing CABG surgery.
- To explore the potential 'smoker's paradox' in this patient population.
Main Methods:
- A retrospective analysis of 6,531 patients from the China Heart Failure Surgery Registry database.
- Patients with left ventricular ejection fraction <50% undergoing isolated CABG were included.
- Multivariate regression and 1-1 propensity score matching were employed to analyze data from 3,635 smokers and 2,896 non-smokers.
Main Results:
- Overall in-hospital mortality was 3.9%.
- Current smokers exhibited significantly lower in-hospital mortality compared to non-smokers (2.3% vs. 4.9%; adjusted OR 0.612).
- No significant difference in mortality was observed between ex-smokers and non-smokers.
Conclusions:
- A paradoxical finding of lower in-hospital mortality in current smokers compared to non-smokers undergoing CABG surgery was observed.
- Further research is warranted to elucidate the biological mechanisms underlying this 'smoker's paradox'.
Background:
Data on the effect of smoking on In-hospital outcome in patients with left ventricular dysfunction undergoing coronary artery bypass graft (CABG) surgery are limited. We sought to determine the influence of smoking on CABG patients with left ventricular dysfunction.
Methods:
A retrospective study was conducted using data from the China Heart Failure Surgery Registry database. Eligible patients with left ventricular ejection fraction less than 50% underwent isolated CABGS were included. In addition to the use of multivariate regression models, a 1-1 propensity scores matched analysis was performed. Our study (n = 6531) consisted of 3635 smokers and 2896 non-smokers. Smokers were further divided into ex-smokers (n = 2373) and current smokers (n = 1262).
Results:
The overall in-hospital morality was 3.9%. Interestingly, current smokers have lower in-hospital mortality than non-smokers [2.3% vs 4.9%; adjusted odds ratio (OR) 0.612 (95% CI 0.395-0.947) ]. No difference was detected in mortality between ex-smokers and non-smokers [3.6% vs 4.9%; adjusted OR 0.974 (0.715-1.327)]. No significant differences in other clinical end points were observed. Results of propensity-matched analyses were broadly consistent.
Conclusions:
It is paradoxically that current smokers had lower in-hospital mortality than non-smokers. Future studies should be performed to further understand the biological mechanisms that may explain this 'smoker's paradox' phenomenon.
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