Abstract
Objectives: To evaluate the impact of smoking status on short-term clinical outcomes of Drug Eluting Stents (DES) in patients with stable coronary artery disease.
Methodology: This cross sectional study was carried out at the Department of Cardiology, Lady Reading Hospital Peshawar from April 2011 to July 2012. It included all patients with stable coronary disease undergoing DES implantation. Smoking status was assessed on the basis of information obtained from hospital medical records at the time of first medical examination and rechecked by telephone interview. All patients were classified as non-smokers and smokers. Clinical outcomes (Myocardial infarction [MI]. unstable angina [UA]. and positive ETT) at three months stratified by smoking status were measured in patients who received DES for coronary artery lesions. All patients were followed and reassessed after 3 months from the index procedure. Exercise Tolerance Test (ETT) was performed on every patient and recorded on proforma. Data analysis was done using SPSS version 16.
Results: A total of 376 patients were enrolled in this study. The mean age was 57 +/- 9.313 years. Males were 271(72.1%). Among 376 patients who were followed up, 70 of them were smokers (18.6%) at the index procedure, 306 patients (81.4%) were non-smokers. The frequency of dyslipidemia and diabetes mellitus was higher in smokers as compared to non-smokers. Mean stent length in smokers was 27.824 +/- 6.23mm as compared to 26.592 +/- 4.73mm in nonsmokers. Mean stent diameter was 2.91 +/- 0.347mm in smoker group while it was 3.01 +/- 0.141mm in non-smoker group. Most of the patients in both groups underwent DES implantation to LAD and LCx arteries. There were significantly higher rates of myocardial infarction (7.1% vs 2%, p<0.036),unstable angina (22.9% vs 3.3%, p<0.001) and positive ETT (30% vs 5.2%, p<0.001) in the smoker group as compared to non-smoker group.
Conclusion: This study provides evidence that smokers treated with DES experience higher rates of myocardial infarction, unstable angina and positive ETT at three months as compared to non-smokers, particularly in the setting of stable coronary artery disease.