Advertisement

Life-Years Gained by Smoking Cessation After Percutaneous Coronary Intervention

      Previous studies have shown that smoking cessation after a cardiac event reduces the risk of subsequent mortality in patients. The aim of this study was to describe the effect of smoking cessation in terms of prolonged life-years gained. The study sample comprised 856 patients who underwent percutaneous coronary intervention (PCI; balloon angioplasty) during 1980 to 1985. Patients were followed up for 30 years and smoking status at 1 year could be retrieved in 806 patients. The 27 patients who died within 1 year were excluded from the analysis. The median follow-up was 19.5 years (interquartile range 6.0 to 23.0). Cumulative 30-year survival rate was 29% in the group of patients who quit smoking and 14% in persistent smokers (p = 0.005). After adjustment for baseline characteristics at the time of PCI, smoking cessation remained an independent predictor of lesser mortality (adjusted hazard ratio 0.57, 95% confidence interval 0.46 to 0.71). The estimated life expectancy was 18.5 years in those who quit smoking and 16.4 years in the persistent smokers (p <0.0001). In conclusion, in patients with coronary heart disease who underwent PCI in the late 1980s, smoking cessation resulted in at least 2.1 life-years gained.
      To read this article in full you will need to make a payment

      References

        • Doll R.
        • Peto R.
        • Wheatley K.
        • Gray R.
        • Sutherland I.
        Mortality in relation to smoking: 40 years' observations on male British doctors.
        BMJ. 1994; 309: 901-911
        • Price J.F.
        • Mowbray P.I.
        • Lee A.J.
        • Rumley A.
        • Lowe G.D.
        • Fowkes F.G.
        Relationship between smoking and cardiovascular risk factors in the development of peripheral arterial disease and coronary artery disease: Edinburgh Artery Study.
        Eur Heart J. 1999; 20: 344-353
        • Doll R.
        • Gray R.
        • Hafner B.
        • Peto R.
        Mortality in relation to smoking: 22 years' observations on female British doctors.
        Br Med J. 1980; 280: 967-971
        • Hammond E.C.
        • Horn D.
        Smoking and death rates; report on forty-four months of follow-up of 187,783 men. II. Death rates by cause.
        J Am Med Assoc. 1958; 166: 1294-1308
        • Ambrose J.A.
        • Barua R.S.
        The pathophysiology of cigarette smoking and cardiovascular disease: an update.
        J Am Coll Cardiol. 2004; 43: 1731-1737
        • Friedman G.D.
        • Dales L.G.
        • Ury H.K.
        Mortality in middle-aged smokers and nonsmokers.
        N Engl J Med. 1979; 300: 213-217
        • Vlietstra R.E.
        • Kronmal R.A.
        • Oberman A.
        • Frye R.L.
        • Killip 3rd, T.
        Effect of cigarette smoking on survival of patients with angiographically documented coronary artery disease. Report from the CASS registry.
        JAMA. 1986; 255: 1023-1027
        • van Domburg R.T.
        • Meeter K.
        • van Berkel D.F.
        • Veldkamp R.F.
        • van Herwerden L.A.
        • Bogers A.J.
        Smoking cessation reduces mortality after coronary artery bypass surgery: a 20-year follow-up study.
        J Am Coll Cardiol. 2000; 36: 878-883
        • Hasdai D.
        • Garratt K.N.
        • Grill D.E.
        • Lerman A.
        • Holmes Jr., D.R.
        Effect of smoking status on the long-term outcome after successful percutaneous coronary revascularization.
        N Engl J Med. 1997; 336: 755-761
        • Rosenberg L.
        • Kaufman D.W.
        • Helmrich S.P.
        • Shapiro S.
        The risk of myocardial infarction after quitting smoking in men under 55 years of age.
        N Engl J Med. 1985; 313: 1511-1514
        • Johansson S.
        • Bergstrand R.
        • Pennert K.
        • Ulvenstam G.
        • Vedin A.
        • Wedel H.
        • Wilhelmsson C.
        • Wilhelmsen L.
        • Aberg A.
        Cessation of smoking after myocardial infarction in women. Effects on mortality and reinfarctions.
        Am J Epidemiol. 1985; 121: 823-831
        • Gordon T.
        • Kannel W.B.
        • McGee D.
        • Dawber T.R.
        Death and coronary attacks in men after giving up cigarette smoking. A report from the Framingham Study.
        Lancet. 1974; 2: 1345-1348
        • Critchley J.A.
        • Capewell S.
        Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review.
        J Am Coll Cardiol. 2003; 290: 86-97
      1. Percutaneous transluminal coronary angioplasty.
        Lancet. 1979; 2: 235-236
        • Detre K.
        • Holubkov R.
        • Kelsey S.
        • Cowley M.
        • Kent K.
        • Williams D.
        • Myler R.
        • Faxon D.
        • Holmes Jr., D.
        • Bourassa M.
        • Block P.
        • Gosselin A.
        • Bentivoglio L.
        • Leatherman L.
        • Dorros G.
        • King III, S.
        • Galichia J.
        • Al-Bassam M.
        • Leon M.
        • Robertson T.
        • Passamani E.
        The Co-investigators of the National Heart, Lung, and Blood Institute's Percutaneous Transluminal Coronary Angioplasty Registry. Percutaneous transluminal coronary angioplasty in 1985-1986 and 1977-1981.
        N Engl J Med. 1988; 318: 265-270
        • Ruygrok P.N.
        • de Jaegere P.T.
        • van Domburg R.T.
        • van den Brand M.J.
        • Serruys P.W.
        • de Feyter P.J.
        Clinical outcome 10 years after attempted percutaneous transluminal coronary angioplasty in 856 patients.
        J Am Coll Cardiol. 1996; 27: 1669-1677
        • Sterne J.A.
        • White I.R.
        • Carlin J.B.
        • Spratt M.
        • Royston P.
        • Kenward M.G.
        • Wood A.M.
        • Carpenter J.R.
        Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls.
        BMJ. 2009; 338: b2393
        • van Domburg R.T.
        • Sonnenschein K.
        • Nieuwlaat R.
        • Kamp O.
        • Storm C.J.
        • Bax J.J.
        • Simoons M.L.
        Sustained benefit 20 years after reperfusion therapy in acute myocardial infarction.
        J Am Coll Cardiol. 2005; 46: 15-20
        • van Domburg R.T.
        • op Reimer W.S.
        • Hoeks S.E.
        • Kappetein A.P.
        • Bogers A.J.
        Three life-years gained from smoking cessation after coronary artery bypass surgery: a 30-year follow-up study.
        Am Heart J. 2008; 156: 473-476
        • Stead L.F.
        • Perera R.
        • Bullen C.
        • Mant D.
        • Lancaster T.
        Nicotine replacement therapy for smoking cessation.
        Cochrane Database Syst Rev. 2008; : CD000146
        • Ranney L.
        • Melvin C.
        • Lux L.
        • McClain E.
        • Lohr K.N.
        Systematic review: smoking cessation intervention strategies for adults and adults in special populations.
        Ann Intern Med. 2006; 145: 845-856
        • Ludvig J.
        • Miner B.
        • Eisenberg M.J.
        Smoking cessation in patients with coronary artery disease.
        Am Heart J. 2005; 149: 565-572
      2. STIVORO. Kerncijfers roken in nederland 2010. Een overzicht van recente nederlandse basisgegevens over rookgedrag. 2011.

        • Deckers J.W.
        • Veerhoek R.J.
        • Smits P.C.
        • Jansen C.G.
        [Trends in prevalence of cardiovascular risk factors and their treatment in coronary heart disease: the Euroaspire-project].
        Ned Tijdschr Geneeskd. 2010; 154: A1229
        • Bittl J.A.
        Advances in coronary angioplasty.
        N Engl J Med. 1996; 335: 1290-1302
        • Serruys P.W.
        • Kutryk M.J.
        • Ong A.T.
        Coronary-artery stents.
        N Engl J Med. 2006; 354: 483-495
        • Al Suwaidi J.
        • Holmes Jr., D.R.
        • Salam A.M.
        • Lennon R.
        • Berger P.B.
        Impact of coronary artery stents on mortality and nonfatal myocardial infarction: meta-analysis of randomized trials comparing a strategy of routine stenting with that of balloon angioplasty.
        Am Heart J. 2004; 147: 815-822
        • Scholte op Reimer W.
        • de Swart E.
        • De Bacquer D.
        • Pyorala K.
        • Keil U.
        • Heidrich J.
        • Deckers J.W.
        • Kotseva K.
        • Wood D.
        • Boersma E.
        Smoking behaviour in European patients with established coronary heart disease.
        Eur Heart J. 2006; 27: 35-41
        • Patrick D.L.
        • Cheadle A.
        • Thompson D.C.
        • Diehr P.
        • Koepsell T.
        • Kinne S.
        The validity of self-reported smoking: a review and meta-analysis.
        Am J Public Health. 1994; 84: 1086-1093