title: Smoking status and survival: impact on mortality of continuing to smoke one year after the angiographic diagnosis of coronary artery disease, a prospective cohort study.
abstract: BACKGROUND
  Smoking is an undertreated risk factor for coronary artery disease (CAD) and is associated with adverse outcomes after myocardial infarction. Aims of our study were to determine if management of CAD by medical therapy (MT) alone or with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) influence smoking status at one year following angiography and if a change in smoking status at one year influences long term survival.
  
  
  METHODS
  Prospective cohort study using the APPROACH registry. Two cohorts were examined: (1) 11,334 patients who returned a one year follow-up questionnaire; (2) 4,246 patients propensity-matched based on their post-angiography treatment - MT or revascularization (RV). Multivariate modeling and survival analysis were used.
  
  
  RESULTS
  In the propensity-matched cohort, quit rates at one year were greater among CABG patients (68%) than PCI (37%) or MT patients (47%). Smokers in the RV group, who self-reported quitting at one year, had a significantly reduced mortality compared to those who continued to smoke.
  
  
  CONCLUSIONS
  CABG patients were more likely to quit smoking than those treated with MT alone or PCI. Quitting smoking was associated with improved long-term survival; smoking remains a key risk factor for mortality in patients with CAD. These data underscore the importance of nicotine addiction management in patients with CAD and the need to emphasize cessation particularly in those patients undergoing MT or PCI.
authors.forename: Fadi
authors.initials: F
authors.lastname: Hammal
authors.forename: Justin A
authors.initials: JA
authors.lastname: Ezekowitz
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Norris
authors.forename: T Cameron
authors.initials: TC
authors.lastname: Wild
authors.affiliation: Department of Anesthesiology & Pain Medicine, University of Alberta, 8-120 Clinical Sciences Building, Edmonton, Alberta T6G2G3, Canada. bfinegan@ualberta.ca.
authors.forename: Barry A
authors.initials: BA
authors.lastname: Finegan
mesh_terms: D000368:Aged; D000416:Alberta; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011237:Predictive Value of Tests; D057216:Propensity Score; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012907:Smoking / Q000009:adverse effects / Q000401:mortality / Q000523:psychology; D016540:Smoking Cessation / Q000523:psychology; D000074606:Smoking Prevention; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome