Abstract 3467: In Patients Undergoing Percutaneous Coronary Intervention, Current Smoking Status is Associated with Predictors of Poor Prognosis and Increased Long-Term Mortality
Background Previous studies suggest that current smoking may paradoxically confer a survival advantage following acute myocardial infarction. However, the impact of smoking on long-term mortality in all patients receiving coronary artery stenting has not been examined.
Methods Mayo Clinic PCI Registry was used to retrospectively analyze smoking status and mortality in all patients receiving coronary artery stenting from 1995–2005. Mortality was determined by yearly telephone contact and review of hospital records.
Results A total of 11 706 patients were included in the study and were divided into never smoked (n=4263), former smoker (n=5357), < 20 pack year history (n=169), 20 – 40 pack year history (n=925) and 40+ pack year history (n=991) at the time of PCI. Compared to the never smoked group, all three groups of current smokers were younger, more often men and had a lower incidence of diabetes, hypertension, prior PTCA, prior CABG, prior stroke or TIA. Current smokers had higher median levels of pre-procedural CK-MB (5.0 vs. 3.2; p<0.001), troponin T (0.14 vs. 0.03; p < 0.001) and white blood cell count (9.0 vs. 7.4; p< 0.001), all of which are poor prognostic predictors. There were 1832 deaths after a median follow-up of 5 years. Despite the lower incidence of co-morbidities, current smokers with > 20 pack year history and former smokers had a significantly higher risk-adjusted mortality (Figure 1⇓).
Conclusions Prior studies describing the “smoker’s paradox” were mainly based on 30 day to 1 year follow-up in patients who had acute myocardial infarction only. This study suggests a detrimental effect of smoking on long-term mortality in patients receiving coronary artery stenting.