No Paradoxical Effect of Smoking Status on Recurrent Cardiovascular Events in Patients Following Percutaneous Coronary Intervention: Thai PCI Registry
Issued Date
2022-05-27
Resource Type
eISSN
2297055X
Scopus ID
2-s2.0-85138718920
Journal Title
Frontiers in Cardiovascular Medicine
Volume
9
Rights Holder(s)
SCOPUS
Bibliographic Citation
Frontiers in Cardiovascular Medicine Vol.9 (2022)
Suggested Citation
Limpijankit T., Chandavimol M., Srimahachota S., Siriyotha S., Thakkinstian A., Krittayaphong R., Sansanayudh N. No Paradoxical Effect of Smoking Status on Recurrent Cardiovascular Events in Patients Following Percutaneous Coronary Intervention: Thai PCI Registry. Frontiers in Cardiovascular Medicine Vol.9 (2022). doi:10.3389/fcvm.2022.888593 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/85864
Title
No Paradoxical Effect of Smoking Status on Recurrent Cardiovascular Events in Patients Following Percutaneous Coronary Intervention: Thai PCI Registry
Other Contributor(s)
Abstract
Background: “Smoker's paradox” is a controversial phenomenon that describes an unexpectedly favorable short-term outcome of smokers post-percutaneous coronary intervention (PCI). This study aimed to evaluate the effect of smoking status on recurrent major adverse cardiovascular events (MACEs) in patients who recently underwent PCI and to determine whether it was paradoxical. Methods: This study utilized data from the nationwide Thai PCI registry, enrolling patients during 2018–2019. Our study factor was smoking status, classified as current smokers, ex-smokers, and nonsmokers. The outcome of interest was the time to occurrence of a composite of MACEs (i.e., all-cause death, myocardial infarction (MI), stroke, and unplanned revascularization) evaluated at about 1-year post-PCI. A propensity score (PS) model using inverse probability weighting with regression adjustment was used to estimate the effect of smoking on the occurrence of MACE. Results: Current smokers, ex-smokers, and non-smokers accounted for 23, 32, and 45% of the 22,741 subjects, respectively. Smokers were younger, more frequently male, and had fewer traditional atherosclerotic risk factors. Current smokers presented more frequently with ST-elevation MIs (STEMIs) and cardiogenic shock (54 and 14.6%, respectively) than non-smokers. MACE rates were 1.9, 1.2, and 1.6 per 100 patients per month in the current smokers, ex-smokers, and non-smokers, respectively. After applying a PS, patients with a history of current smoking and ex-smoking developed the onset of recurrent MACEs significantly sooner than non-smokers, with a median time of 4.4 vs. 4.9 vs. 13.5 months (p < 0.001), respectively. Conclusions: “Smoker's paradox” was not observed in our patient population. Current smokers and ex-smokers were prone to develop an earlier onset of a post-PCI MACEs than nonsmokers and need a smoke cessation program for further prevention.