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Incidence of strut coverage higher in current smokers
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In a study of the effect of cigarette smoking on vascular healing after sirolimus-eluting stent implantation, optical coherence tomographic evaluation revealed that the incidence of strut coverage was higher but the pattern of neointima was more heterogeneous in current smokers compared with nonsmokers.
The study included 140 patients (181 sirolimus-eluting stents) from the Massachusetts General Hospital OCT Registry who had follow-up OCT. Patients were classified as current smokers (n = 28), former smokers (n = 35) or nonsmokers (n = 77).
The incidence of uncovered stent struts was 13.3 ± 13.3% in nonsmokers vs. 6.7 ± 8.3% in current smokers (P = .001).
The prevalence of heterogeneous neointima was 71.9% in current smokers vs. 36% (P = .004) in former smokers and 10.1% in nonsmokers (P < .001).
Current, former and no smoking status were associated with similar incidence rates of malapposition.
Multivariable analysis revealed a negative association between current smoking and the presence of uncovered struts (OR = 0.33; 95% CI, 0.14-0.79) and a positive association between current smoking and the presence of heterogeneous neointima (OR = 9.47; 95% CI, 3.79-23.72).
“Our finding of increased percentage of uncovered struts in nonsmokers was unexpected,” the researchers concluded. “Nevertheless, multivariate model confirmed that current smoking is negatively correlated with uncovered struts at follow-up.”
In other results, diabetes was independently associated with the presence of uncovered struts.
Current smokers in this study were significantly younger than former and nonsmokers. Additionally, current smokers were more likely to be male and have ACS compared with nonsmokers. – by Rob Volansky
Disclosure: One researcher reports associations with St. Jude Medical.
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