Correlation Between Smoking Paradox and Heart Rhythm Outcomes in Patients With Coronary Artery Disease Receiving Percutaneous Coronary Intervention

Han-Ping Wu; Sheng-Ling Jan; Shih-Lin Chang; Chia-Chen Huang; Mao-Jen Lin

doi:10.3389/fcvm.2022.803650

Correlation Between Smoking Paradox and Heart Rhythm Outcomes in Patients With Coronary Artery Disease Receiving Percutaneous Coronary Intervention

Front Cardiovasc Med. 2022 Feb 11:9:803650. doi: 10.3389/fcvm.2022.803650. eCollection 2022.

Authors

Han-Ping Wu^{1

2

3}, Sheng-Ling Jan^{4

5

6}, Shih-Lin Chang^{5

7}, Chia-Chen Huang⁸, Mao-Jen Lin^{9

10}

Affiliations

¹ Department of Pediatric Emergency Medicine, China Medical University Children's Hospital, China Medical University, Taichung, Taiwan.
² Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
³ Department of Medical Research, China Medical University Children's Hospital, China Medical University, Taichung, Taiwan.
⁴ Department of Pediatrics, Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan.
⁵ School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.
⁶ School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁷ Department of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.
⁸ Department of Public Health, Chung Shan Medical University, Taichung, Taiwan.
⁹ Department of Medicine, Taichung Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.
¹⁰ Department of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan.

Abstract

Background: The effect of smoking on short-term outcomes among patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) is controversial. However, little is known about the impact of smoking on long-term outcomes in patients with stable coronary artery disease (CAD) who receive PCI.

Methods: A total of 2,044 patients with stable CAD undergoing PCI were evaluated. They were divided into two groups according to smoking status (current smokers vs. non-smokers). Baseline characteristics, exposed risk factors, angiographic findings, and interventional strategies were assessed to compare the long-term clinical outcomes between groups. Predictors for myocardial infarction (MI), all-cause death, cardiovascular (CV) death, and repeated PCI procedures were also analyzed.

Results: Compared with non-smokers, current smokers were younger and mostly male (both P < 0.01). They also had a lower prevalence of chronic kidney disease (CKD) and diabetes (both P < 0.01). Drugs including a P2Y12 receptor inhibitor of platelets (P2Y12 inhibitor), beta-blockers (BB), and statins were used more frequently in current smokers (P < 0.01, P < 0.01, P = 0.04, respectively). Freedom from all-cause death and CV death was lower in the non-smoker group (P < 0.001, P = 0.003, respectively). After adjustment, logistic regression revealed smoking was a major predictor for all-cause death and repeated PCI procedure [hazard ratio(HR): 1.71 and 1.46, respectively].

Conclusions: Smoker's paradox extends to long-term outcome in patients with stable CAD undergoing PCI, which is partially explained by differences in baseline characteristics. However, smoking strongly predicted all-cause mortality and repeated PCI procedures in patients with stable CAD undergoing PCI.

Keywords: long-term outcome; percutaneous coronary intervention; risk factors; smoker's paradox; stable coronary artery disease.