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Published on: March 27, 2018
Smoking and long-term risks for morbidity and mortality after coronary artery bypass grafting
Emelie Johansson1,2, Malin Stenman3,4, Emma C Hansson1,2
1Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
Insights
Smoking significantly increases long-term risks for mortality and major adverse cardiovascular events (MACE) after coronary artery bypass grafting (CABG). Current smokers face the highest risks, underscoring the need for smoking cessation support post-CABG.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Coronary artery bypass grafting (CABG) is a critical intervention for cardiovascular disease.
- The long-term impact of smoking on outcomes following CABG requires further investigation.
- Understanding smoking-related risks is crucial for patient management and public health strategies.
Purpose of the Study:
- To investigate the association between smoking status and long-term morbidity and mortality in patients who underwent CABG.
- To quantify the risks of major adverse cardiovascular events (MACE), all-cause mortality, and stroke in current and former smokers compared to never smokers post-CABG.
- To highlight the importance of smoking cessation in improving patient outcomes after CABG.
Main Methods:
- A population-based registry study utilizing data from the SWEDEHEART registry.
- Inclusion of 27,434 patients who underwent CABG between 2010 and 2020, categorized into never, former, and current smokers.
- Analysis using adjusted Cox regression models to estimate hazard ratios for mortality and morbidity, with a median follow-up of 5 years.
Main Results:
- Current smokers exhibited higher risks for MACE (aHR 1.52), all-cause mortality (aHR 1.91), and stroke (aHR 1.49) compared to never smokers.
- Compared to former smokers, current smokers had increased risks for MACE (aHR 1.38), all-cause mortality (aHR 1.53), and stroke (aHR 1.36).
- No significant increased risk for myocardial infarction was observed in current smokers compared to never smokers (aHR 1.07) or former smokers (aHR 1.15).
Conclusions:
- A strong association exists between smoking and increased long-term risks of mortality and morbidity after CABG.
- Current smokers face the most substantial risks, emphasizing the critical need for smoking cessation interventions.
- Motivating patients to quit smoking before CABG is essential for optimizing long-term health outcomes.
Background:
We explored the association between smoking and long-term risks of morbidity and mortality in patients who had undergone coronary artery bypass grafting (CABG).
Methods:
This population-based registry study included 27,434 patients (mean age 67.9 years, 18.2 % women), divided into: never smokers (n = 8,593), former smokers (n = 14,666) and current smokers (n = 4,175), who underwent CABG between 2010 and 2020. Data were collected from the SWEDEHEART registry. Three other mandatory registers provided data on comorbidities, social factors and outcome variables. Adjusted Cox regression models were used to estimate mortality and morbidity. The median follow-up was 5 (0-11) years.
Results:
Current smokers were younger and had a higher proportion of previous myocardial infarction, heart failure, chronic respiratory disease, depression and low education compared with never smokers. Compared with never smokers, current smokers had higher risk for a major adverse cardiovascular event (MACE) (adjusted hazard ratio (aHR) 1.52, 95 % confidence interval (CI) 1.39-1.66), all-cause mortality (aHR 1.91, (1.71-2.14)) and stroke (aHR 1.49, (1.27-1.74)) but not for myocardial infarction (aHR 1.07, (0.91-1.26)). Compared with former smokers, current smokers had an increased risk for MACE (aHR 1.38, (1.27-1.49)), all-cause mortality (aHR 1.53, (1.39-1.69)), stroke (aHR 1.36, (1.18-1.56)), but not for myocardial infarction (aHR 1.15, (1.00-1.34)).
Conclusions:
There was a strong association between smoking and long-term risk for mortality and morbidity after CABG. The highest risks were observed in current smokers. The results emphasize the importance of motivating CABG patients to smoking cessation before considering CABG as a treatment option.
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