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CLINICAL STUDY

Smoking cessation reduces mortality after coronary artery bypass surgery: a 20-year follow-up study

^a Thoraxcenter, University Hospital Rotterdam Dijkzigt, Rotterdam, the Netherlands

Manuscript received December 8, 1999; revised manuscript received March 1, 2000, accepted April 12, 2000.

Reprint requests and correspondence: Dr. R. T. van Domburg, University Hospital Rotterdam Dijkzigt, Thoraxcenter, Location 5 Midden, Room H553, the Netherlands
vandomburg{at}thch.azr.nl

OBJECTIVES

The goal of this study was to determine the influence of smoking cessation on mortality after coronary artery bypass graft surgery (CABG), which has still not been established clearly.

BACKGROUND

Cigarette smoking is one of the known major risk factors of coronary artery disease.

METHODS

One thousand and forty-one patients underwent CABG between 1971 and 1980. The preoperative and postoperative smoking habits of 985 patients (95%) could be retrieved and were analyzed in a multivariate Cox analysis.

RESULTS

The median follow-up was 20 years (range 13 to 26 years). Smoking status before surgery did not entail an increased risk of mortality: patients who had smoked before surgery and those who had not smoked in the year before surgery had a similar probability of survival. However, smoking cessation after surgery was an important independent predictor of a lower risk of death and coronary reintervention during the 20-year follow-up when compared with patients who continued smoking. In analyses adjusted for baseline characteristics, the persistent smokers had a greater relative risk (RR) of death from all causes (RR 1.68 [95% confidence interval 1.33 to 2.13]) and cardiac death (RR 1.75 [1.30 to 2.37]) as compared with patients who stopped smoking for at least one year after surgery. The estimated benefit of survival for the quitters increased from 3% at five years to 14% at 15 years. The quitters were less likely to undergo repeat CABG or a percutaneous coronary angioplasty procedure (RR 1.41 [1.02 to 1.94]).

CONCLUSIONS

Patients who continued to smoke after CABG had a greater risk of death than patients who stopped smoking. They also underwent repeat revascularization procedures more frequently. Cessation of smoking is therefore strongly recommended after CABG. Clinicians are encouraged to start or to continue smoking-cessation programs in order to help smokers to quit smoking, especially after CABG.

Abbreviations and Acronyms   CABG = coronary artery bypass graft surgery   CI = confidence interval   MI = myocardial infarction   PTCA = percutaneous transluminal coronary angioplasty   RR = relative risk

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