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In ACS after PCI, death rates in smokers lower
Smokers with ACS who are treated with PCI may be at lower risk for mortality than nonsmokers, which could be due to younger age, male sex, lower incidence of diabetes and the extent of CAD, according to a study published in The American Journal of Cardiology.
“Several studies have found improved mortality in smokers after ACS, especially in the thrombolytic era,” Sharan P. Sharma, MD, internal medicine specialist at University of New England, LRGHealthcare, in Laconia, New Hampshire, and colleagues wrote. “We aimed to assess the association of smoking status with mortality and cardiovascular outcomes in patients with ACS treated with PCI.”
Researchers conducted a meta-analysis of 17 randomized and nonrandomized studies that included 55,491 patients (21,989 smokers; 33,502 nonsmokers).
The primary outcome was all-cause mortality, with MACE, MI, and target vessel revascularization as the secondary outcomes. Outcomes were measured at 30 days and 1 year.
To examine the association between changes in mortality and selected covariates, the researchers used meta-regression.
Sharma and colleagues found that smokers had lower mortality than nonsmokers at 30 days (2.3% vs. 3.3%; OR = 0.54; 95% CI, 0.39-0.76; I2 = 74%) and 1 year (2.3% vs. 3.6%; OR = 0.54; 95% CI, 0.3-0.7; I2 = 77%).
The results of the meta-regression demonstrated that lower mortality in smokers was associated with younger age, male sex and less incidence of diabetes.
There were no significant differences between smokers and nonsmokers related to MI, MACE or TVR, according to the researchers.
“Smoking continues to be one of the risk factors (with hyperlipidemia, hypertension or diabetes) accounting for major coronary artery disease burden,” the researchers wrote. “Our results showing association between smoking and lower mortality after PCI in acute coronary syndrome should not be taken as an endorsement for smoking or rationale for continuation of smoking after ACS. Efforts to encourage smoking cessation by health care providers should continue to be a major public health priority.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.