Impact of smoking on the outcome of patients treated with drug-eluting stents: 1-year results from the prospective multicentre German Drug-Eluting Stent Registry (DES.DE).
BACKGROUND
Cigarette smoking strongly increases morbidity and mortality from cardiovascular causes, but the relevance of smoking in patients treated with drug-eluting stents (DES) is unknown.


OBJECTIVE
To assess the impact of smoking on the presentation and outcome of patients treated with DES.


RESULTS
We analyzed data from the prospective multicentre German Drug-Eluting Stent Registry (DES.DE) and identified 1,122 patients who had never smoked and 1,052 patients who were current smokers. Smokers were younger (56.5 vs. 69.4 years, p < 0.0001), more often males, with less frequent diabetes and hypertension compared to non-smokers. Smokers presented more often with acute coronary syndromes. After a mean follow-up of 12.5 months, smokers had both higher mortality (4.6 vs. 2.7%, p < 0.05) and myocardial infarction (MI) rates (4.9 vs. 3%, p < 0.01). There was no significant difference between smokers and non-smokers in the rate of target vessel revascularization (9.8 vs. 11.4%, p = 0.26). Major adverse cardiac and cerebrovascular events (defined as the composite of death, MI and stroke, MACCE) were higher in smokers (10.6 vs. 6.1%, p < 0.001). Moreover, after adjustment for baseline clinical and angiographic variables, smoking continued to be a strong independent predictor for MACCE (OR = 2.34, 95% CI 1.49-3.68). In a subgroup analysis, we found that the increased risk of smoking was most prominent in patients presenting with stable angina pectoris (OR = 3.71, 95% CI 1.24-2.57, p < 0.05). Smoking almost doubled the risk for MACCE in acute MI patients, though this did not reach statistical significance (adjusted OR = 1.91, 95% CI 0.93-3.94, p = 0.74).


CONCLUSIONS
This large multicentre DES registry provides evidence that smokers treated with DES, despite lower incidence of predisposing risk factors for atherosclerosis, experience higher rates of death and MI compared to non-smokers, particularly in the setting of stable coronary artery disease. Smoking has only marginal effects on target vessel revascularization rates in patients treated with DES.
Herz-Kreislauf-Zentrum, Segeberger Kliniken GmbH, Bad Segeberg, Germany. mohammad_sherif@hotmail.com
Mohammad A
MA
Sherif
Christoph A
CA
Nienaber
Ralph
R
Toelg
Mohamed
M
Abdel-Wahab
Volker
V
Geist
Steffen
S
Schneider
Jochen
J
Senges
Karl-Heinz
KH
Kuck
Ulrich
U
Tebbe
Gert
G
Richardt
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents; D005260:Female; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D016017:Odds Ratio; D011446:Prospective Studies; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D020521:Stroke / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome