[Impact of smoking on the results of coronary artery bypass surgery].
OBJECTIVE
The proportion of patients undergoing coronary artery bypass surgery (CABG) with a history of smoking is increasing. The aim of this study was to examine the effect of smoking on outcomes following CABG.


METHODS
6,367 consecutive patients who underwent CABG between April 1997 and March 2003 were analyzed retrospectively. Logistic regression was used to risk-adjust inhospital outcomes, while Cox proportional hazards analysis was used to risk-adjust Kaplan-Meier survival curves. Outcomes were adjusted for variables suggested by the American Heart Association and the American College of Cardiology.


RESULTS
947 patients (14.9%) were current smokers (smoking within 1 month of surgery), while 3,857 (60.6%) were ex-smokers and 1,563 (24.5%) nonsmokers. After adjusting for differences in case-mix, current smokers were more likely to develop chest infections (p < 0.001), atelectasis (p < 0.001), and require ventilation > 48 h (p = 0.003). Current smokers were also more likely to stay in intensive care for > 3 days (p < 0.001). There was no association between smoking status and in-hospital mortality. Ex-smokers were not associated with excess mortality (p = 0.11), while current smokers had significantly increased mortality during follow-up (p = 0.029).


CONCLUSIONS
Current smokers are associated with increased respiratory complications, and prolonged stay on intensive care. Although not associated with in-hospital mortality, there appears to be a significant increase in mortality in smokers during a 4-year follow-up period. Patients should be encouraged to stop smoking to maximize the long-term benefits of CABG.
Mortasawi
Amir
A
Thoraxklinik am Universitätsklinikum Heidelberg, Heidelberg. amirmortasawi@yahoo.de
Ashraf
Mohammed Nadeem
MN
Grayson
Antony David
AD
Oo
Aung Ye
AY
D000368:Aged; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000401:mortality* / Q000601:surgery*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012907:Smoking / Q000401:mortality*; D016540:Smoking Cessation / Q000706:statistics & numerical data; D016019:Survival Analysis; D016896:Treatment Outcome