Absence of bias against smokers in access to coronary revascularization after cardiac catheterization.
OBJECTIVE
Many consider smoking to be a personal choice for which individuals should be held accountable. We assessed whether there is any evidence of bias against smokers in cardiac care decision-making by determining whether smokers were as likely as non-smokers to undergo revascularization procedures after cardiac catheterization.


METHODS
Prospective cohort study. Subjects and setting. All patients undergoing cardiac catheterization in Alberta, Canada.


METHODS
Patients were categorized as current smokers, former smokers, or never smokers, and then compared for their risk-adjusted likelihood of undergoing revascularization procedures (percutaneous coronary intervention or coronary artery bypass grafting) after cardiac catheterization.


RESULTS
Among 20406 patients undergoing catheterization, 25.4% were current smokers at the time of catheterization, 36.6% were former smokers, and 38.0% had never smoked. When compared with never smokers (reference group), the hazard ratio for undergoing any revascularization procedure after catheterization was 0.98 (95% CI 0.93-1.03) for current smokers and 0.98 (0.94-1.03) for former smokers. The hazard ratio for undergoing coronary artery bypass grafting was 1.09 (1.00-1.19) for current smokers and 1.00 (0.93-1.08) for former smokers. For percutaneous coronary intervention, the hazard ratios were 0.93 (0.87-0.99) for current smokers and 1.00 (0.94-1.06) for former smokers.


CONCLUSIONS
Despite potential for discrimination on the basis of smoking status, current and former smokers undergoing cardiac catheterization in Alberta, Canada were as likely to undergo revascularization procedures as catheterization patients who had never smoked.
Cornuz
Jacques
J
Department of Medicine, University of Lausanne, Lausanne, Switzerland.
Faris
Peter D
PD
Galbraith
P Diane
PD
Knudtson
Merril L
ML
Ghali
William A
WA
D000416:Alberta / Q000453:epidemiology; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D001291:Attitude of Health Personnel; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D011287:Prejudice; D011446:Prospective Studies; D012907:Smoking / Q000453:epidemiology*