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Predictors of smoking cessation after percutaneous coronary revascularization
D Hasdai1, K N Garratt, D E Grill
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic Rochester, MN 55905, USA.
Insights
Younger patients with higher prior cigarette consumption are more likely to continue smoking after percutaneous coronary revascularization. Unstable angina patients were more likely to quit, yet 63% of smokers continued, highlighting the need for smoking cessation counseling.
Area of Science:
- Cardiology
- Public Health
- Addiction Medicine
Background:
- Percutaneous coronary revascularization (PCR) is a common procedure for coronary artery disease.
- Smoking cessation significantly improves outcomes post-PCR.
- Predictors of continued smoking after PCR are not well-defined.
Purpose of the Study:
- To identify factors associated with smoking cessation after successful PCR.
- To inform targeted interventions for smoking cessation in this patient group.
Main Methods:
- Case-control study analyzing smoking status of patients undergoing PCR.
- Follow-up duration of up to 16 years.
- Logistic regression models used to identify predictors of smoking cessation.
Main Results:
- Higher prior cigarette consumption and additional cardiovascular risk factors predicted continued smoking.
- Older age and unstable angina were associated with a lower likelihood of continued smoking.
- 63% of patients continued to smoke post-PCR.
Conclusions:
- Younger patients, those with greater smoking history, and a worse risk profile are less likely to quit smoking after PCR.
- Unstable angina patients demonstrated higher cessation rates.
- There is a critical need for smoking cessation counseling in patients undergoing PCR.
Objective:
To identify factors predictive of smoking cessation after successful percutaneous coronary revascularization.
Material And Methods:
We undertook a case-control study of the smoking status of all patients at Mayo Clinic Rochester from September 1979 through December 1995 who were smokers at the time of an index percutaneous coronary revascularization procedure in the non-peri-infarction setting (no myocardial infarction within 24 hours). Maximal duration of prospective follow-up was 16 years. Patients were classified into those who permanently quit smoking immediately after the procedure (N = 435; mean follow-up, 5.1 +/- 3.7 years) or those who continued to smoke at some time during follow-up (N = 734; mean follow-up, 5.3 +/- 3.7 years). Logistics regression models were formulated to determine independent predictors of smoking cessation.
Results:
Predictors of continued smoking were greater prior cigarette consumption (odds ratio [OR] = 1.009 for each pack-year; 95% confidence interval [CI] = 1.004 to 1.014) and having one or more risk factors for coronary artery disease other than cigarette smoking (OR = 1.49; 95% CI = 1.15 to 1.93). Older age (OR = 0.98 for each additional year; 95% CI = 0.97 to 0.99) and unstable angina at time of initial assessment (OR = 0.69; 95% CI = 0.52 to 0.91) were associated with less likelihood of continued smoking.
Conclusion:
Younger patients with a worse risk profile and greater prior cigarette consumption were more likely than other patients to continue smoking after percutaneous coronary revascularization in the non-peri-infarction setting. Patients who had unstable angina were more likely to quit smoking than those who had stable angina. Despite the proven benefits of smoking cessation after percutaneous coronary revascularization, a substantial proportion of smokers (63%) continue to smoke; thus, smoking-cessation counseling should be addressed in this population.