Impact Of Smoking Status On Patients With Coronary Heart Disease After Percutaneous Coronary Intervention: Analysis Of "Smoker Paradox"

Objective To study clinical outcomes among smoking status at 30-day and 1-year follow-up and 6-month heath-related quality of life in patients undergoing successful percutaneous coronary intervention (PCI). Aim to develop multiple regression models to explore the main risk factor of prognostic predictor.Methods A cohort of 262 consecutive PCI patients at the Heart Institute were observed in a prospective, observational study. Including 262 cases, 211 patients were male, other 51 patients were female, age range 33-80 years (mean, 61.2±10.7), of which 120 case patients who defined Never Smokers, 44 cases were Former Smokers and 98 cases were currently Smoker. Our study including two parts: (1) After successful implementation PCI in all of 262 patients with telephone to investigate the rate of re-hospitalization, re-myocardial infarction, re-angina and major adverse cardiovascular events outcome at 30-day and 1-year follow-up, indicators established in mutil-factor Logistic and Cox- multiple regression model based on the different smoking status of 30 days and 1 year postoperative prognostic risk factors. (2) Included participants in the first part of this study, of which 133 patients were male, 39 females, and age range 33-79 years (62.0±10.56), were consistent with the second part in the selection criteria. Health-Related Quality of Life Surveys (HR-QoLs) that included health status assessments were administered at baseline and at 6-month after intervention. Primary outcome was health status as measured by the Seattle Angina Questionnaire (SAQ) and the Short Form-36 (SF-36).Results (1) The results suggest that current smokers than former smokers and never smokers more younger, shorter disease duration and less hypertension, but was more prone to myocardial infarction. Risk-adjusted statistical models demonstrated that, patients who were current smokers had better prognostic outcomes than other patients after revascularization. Former Smoker and Never Smoker versus Current Smoker in 30-day composited end-point MACE showed that the adjusted odd ratios are OR= 2.35 (95% CI: 0.98-5.63; P = 0.056) and OR= 1.42 (95% CI: 0.70-2.87; P = 0.333). The incidence of re-angina and never smokers than current smokers smoking patients with a poor prognosis, the adjusted OR, respectively (OR = 2.50; 95% CI: 1.03- 6.06; P = 0.042) and (OR = 1.40; 95% CI: 0.68-2.88; P = 0.036). After 1-year follow-up, results showed that currently smoker had a poorer prognosis, in the composite endpoint MACE, former smoker and never smoker than current smoker on adjusted OR were OR =2.32 (95% CI: 1.04-5.16; P = 0.04) and OR = 1.56 (95% CI: 0.84-2.93; P = 0.163), never smokers were not statistically significant. Former smoking patients regardless of the adjustment or unadjustment the incidence of reangina showed better outcome than the current smoking patients, which adjusted OR= 2.38 (95% CI: 1.14- 4.95; P = 0.042), and never-smoking patients also showed no statistical significance. 30-day Cox proportional hazards model in the primary outcome events were combined diabetes and hypertension, the hazard ratio were HR =1.91 (95% CI: 1.04-3.52; P = 0.038) and HR=1.98 (95% CI: 1.07-3 .69; P = 0.030). 1 year of Cox proportional hazards model indicated age and history of smoking were prognosis predictor, their hazard ratio were: age was HR=1.06 (95% CI: 1.02-1.09; P = 0.001), former smoking was HR = 2.30 (95% CI: 1.10- 4.83; P = 0.027), which were statistically significant. (2) 172 participants of the first part of the study met the inclusion criteria were selected to the second part study. The baseline comparison also showed that the age was the confounding factor among smoking status. Similarly, patients who had never smoked and patients who were former smokers reported insignificantly fewer general health, more frequently body pain and more physical limitations, less anginas stability, and a lower quality of life on the SF-36 and SAQ than patients who were current smokers. Smoking status was unrelated to HR-QoLF in the 6-month after revascularization. We could observe this trend by error bar graph objectively.Conclusions Smoking is still the risk factor for coronary heart disease (CHD), current smoking patients than never smokers and former smokers had a higher incidence of myocardial infarction, and they will suffer CHD greatly in advance. "Smokers paradox" phenomenon does exist. We found that regardless of adjusted or unadjusted relative risk, the relative ratio showed that patients who quitted and never smoked than currently smoking patients with poorer prognosis in short-term postoperative follow-up, relative risk of former smokers of adverse outcomes were 2 times than the current smoker, and never smoker insignificantly. This difference may be due to former smokers and never smokers were older than current smoker, also higher blood pressure, more diabetes, and pre-revascularization rates. There is no more evidence proof smoking status on improve quality of life of in post-PCI patients with CHD.