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Smoking cessation and arrhythmic death: the CAST experience. The Cardiac Arrhythmia Suppression Trial (CAST)
R W Peters1, M M Brooks, L Todd
1Department of Medicine, Baltimore Department of Veterans Affairs Medical Center, Maryland 21201, USA.
Insights
Smoking cessation significantly reduced arrhythmic death and overall mortality in high-risk cardiac patients. These findings highlight the importance of quitting smoking for individuals with advanced ischemic heart disease.
Area of Science:
- Cardiology
- Public Health
- Clinical Trials
Background:
- Cigarette smoking is a significant risk factor for sudden cardiac death.
- The benefits and timeline of smoking cessation on cardiovascular outcomes require further delineation.
- The Cardiac Arrhythmia Suppression Trial (CAST) investigated antiarrhythmic drug efficacy post-myocardial infarction.
Purpose of the Study:
- To evaluate the impact of smoking cessation on mortality and arrhythmic death.
- To assess these effects within the specific population of the Cardiac Arrhythmia Suppression Trial (CAST).
Main Methods:
- Analysis of 1,026 smoking patients from the CAST study with 4-month follow-up.
- Categorization into 'quitters' (517) and 'smokers' (509) based on smoking status at follow-up.
Main Results:
- A trend towards reduced arrhythmic and total deaths was observed in quitters versus smokers over ~16 months.
- In a high-risk subgroup (558 patients) without revascularization, smoking cessation significantly reduced arrhythmic death and improved survival.
- Most fatal events occurred in this high-risk cohort, underscoring the impact of smoking in this group.
Conclusions:
- Smoking cessation led to a significant reduction in mortality and arrhythmic death in high-risk cardiac patients.
- These results emphasize smoking cessation as a critical intervention for risk reduction in advanced ischemic heart disease.
Objectives:
This study was performed to assess the effect of cigarette smoking cessation on overall mortality and the incidence of arrhythmic death in the population of the Cardiac Arrhythmia Suppression Trial (CAST).
Background:
Cigarette smoking is a known risk factor for sudden cardiac death. Some of the adverse effects of smoking have been shown to dissipate with smoking cessation, but the time frame over which these changes occur and the population that stands to benefit have not been well delineated. CAST was a multicenter double-blind placebo-controlled study to determine whether suppression of ventricular ectopic activity by means of antiarrhythmic drugs in patients with left ventricular dysfunction after acute myocardial infarction would reduce the incidence of arrhythmic death.
Methods:
Of 2,752 patients randomized to blinded therapy, 1,026 were smoking at the time of their baseline examination and completed a 4-month follow-up visit. Of these, 517 stopped smoking by the time of this visit ("quitters") and 509 continued to smoke ("smokers").
Results:
Over a mean follow-up period of slightly < 16 months, there were 17 arrhythmic deaths and 32 total deaths among the quitters versus 30 and 45, respectively, among the smokers; these differences were of marginal statistical significance. Most of the fatal events occurred in a group at high risk of ongoing ischemia: the 558 patients who did not have thrombolysis or undergo revascularization after their qualifying myocardial infarction. In this high risk cohort, smoking cessation greatly reduced the incidence of arrhythmic death and was associated with a statistically significant benefit in survival.
Conclusions:
Smoking cessation was accompanied by a marked reduction in arrhythmic death and overall mortality that achieved statistical significance in a high risk cohort. These data imply that smoking cessation is important in risk factor reduction in patients with advanced ischemic heart disease.