Bupropion failed to halt smoking in hospitalized acute MI patients

Bupropion immediately after a hospitalized acute MI was well tolerated and safe, but not effective in helping patients quit smoking, according to study findings published in the Journal of the American College of Cardiology.

The ZESCA study was a multicenter, double blind, placebo-controlled, randomized clinical trial of 392 patients who were smokers hospitalized with acute MI (64.9% had STEMI). The mean age of the patients was 53.9 years, and they smoked a mean of 23.2 ± 10.6 cigarettes a day for a mean 32.9 ± 12.4 years. Patients were assigned bupropion or placebo for 9 weeks and received low-intensity smoking cessation therapy.

Mark J. Eisenberg

After 12 months, two-thirds of patients resumed smoking. Continuous abstinence rates were 26.8% in the bupropion group and 22.2% in the placebo group. Rates of major adverse cardiac events were similar between the two groups (13% vs. 11%, respectively).

“Most cardiologists assume and believe their patients quit smoking after a heart attack. This study shows that this is probably not the case,” Mark J. Eisenberg, MD, of the division of cardiology and clinical epidemiology, Jewish General Hospital/McGill University in Montreal, told Cardiology Today.

According to the researchers, “These results suggest that smoking remains a major issue in the patient population with acute MI. These patients have smoked on average, for >3 decades, and despite having a major cardiac event related to smoking, they still have serious difficulty quitting.”

In an editorial commentary, Neal Benowitz, MD, of the division of clinical pharmacology and experimental therapeutics, University of California, San Francisco, and Judith Prochaska, PhD,MPH, of Stanford, wrote: “Smoking cessation is probably the most important thing a smoker with acute MI can do to improve future health.” Based on these health consequences and in conjunction with The Joint Commission’s current recommendations, Benowitz and Prochaska suggested: effective counseling for all smokers; effective transitioning for inpatient and outpatients; personalized medication to help with withdrawal symptoms; and management of the mental health conditions that accompany a smoking relapse. – by Deb Dellapena

For more information:

Benowitz NL. J Am Coll Cardiol. 2013;61:533-535.

Eisenberg MJ. J Am Coll Cardiol. 2013;61:524-532.

Disclosure: See the full study and editorial for a list of the researchers’ relevant financial disclosures.