Impact of smoking status on clinical outcomes after successful chronic total occlusion intervention: Korean national registry of CTO intervention.
OBJECTIVE
We sought to evaluate the effect of cigarette smoking on long-term outcomes after successful percutaneous coronary intervention for chronic total occlusion (CTO) lesions.


BACKGROUND
Cigarette smoking promotes the progression of atherosclerosis but enhances the antiplatelet effect of clopidogrel.


METHODS
The Korea National Registry of CTO Intervention included 2,167 patients with CTO lesions from 26 centers who were successfully revascularized with drug-eluting stents from 2007 to 2009. Thrombotic events were defined as the composite of cardiac death, nonfatal myocardial infarction, and stent thrombosis.


RESULTS
Current-smokers had more favorable baseline characteristics such as a younger age and lower prevalence of hypertension and diabetes mellitus. At 1 year, current-smokers had a significantly lower thrombotic event rate (1.1% vs. 2.7%, P = 0.034), but a significantly higher target vessel revascularization (TVR) rate (7.2% vs. 4.2%, P = 0.017) compared with never-smokers. After adjustment, current-smoking was independently associated with a 72% decreased risk for thrombotic events, and 73% increased risk for TVR.


CONCLUSIONS
In patients with a revascularized CTO lesion, cigarette smoking is associated with fewer thrombotic events but with a higher incidence of TVR. Patients with CTO may benefit from smoking cessation to reduce TVR in conjunction with the use of new more potent antiplatelet agents whose effect is independent of cigarette smoking to improve thrombotic events. © 2015 Wiley Periodicals, Inc.
Cardiovascular Center, Soonchunhyang University Hospital, Seoul, Korea.
Min-Ho
MH
Lee
Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
Jin Joo
JJ
Park
Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
Chang-Hwan
CH
Yoon
Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
Myung-Jin
MJ
Cha
Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
Sang-Don
SD
Park
Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
Il-Young
IY
Oh
Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
Jung-Won
JW
Suh
Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
Young-Seok
YS
Cho
Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
Tae-Jin
TJ
Youn
Korea University Guro Hospital, Seoul, Korea.
Seung-Woon
SW
Rha
Sejong General Hospital, Bucheon, Korea.
Cheol Woong
CW
Yu
Sung-Kyun-Kwan University Samsung Medical Center, Seoul, Korea.
Hyeon-Cheol
HC
Gwon
Yonsei University Severance Hospital, Seoul, Korea.
Yangsoo
Y
Jang
Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
Hyo-Soo
HS
Kim
Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
In-Ho
IH
Chae
Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
Dong-Ju
DJ
Choi
D000368:Aged; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000453:epidemiology / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
chronic total occlusions; outcomes; smoking