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Smoking After Stenting Ups Chest Pain

— Post-PCI angina more common among smokers.

MedpageToday

(Reuters Health) -- People who quit smoking after percutaneous coronary intervention (PCI) have less chest pain and better quality of life than those who keep smoking, according to a new U.S. study.

"Patients are subjecting themselves to the risk of the procedure to alleviate pain, but smoking undermines the benefits of treatment," of Saint Luke's Mid America Heart Institute in Kansas City, Missouri, told Reuters Health.

Spertus and his coauthors studied 2,765 people who had angioplasty at 10 centers in the U.S. About half had smoked in the past but quit before their procedure, 935 had never smoked, 189 quit at the time of their procedure, and 315 continued to smoke after their procedure.

At one year after PCI, patients completed questionnaires assessing their chest pain, physical limitations, and quality of life.

About 30% of continued smokers reported chest pain one year later, compared to 21% of those who had quit and 19% of those who had never smoked, as reported online May 12 in

For two-thirds of smokers who kept smoking, chest pain was also "significantly worse" one year later, compared to the smokers who quit at the time of the procedure, the authors noted.

People who quit smoking at the time of their procedure had better quality of life at one year compared to those who kept smoking. At the time of the procedure, smokers scored about six points lower on a 100-point quality of life scale than never or past smokers. One year later, quality of life scores for people who kept smoking averaged three points lower than those who quit at the time of their procedure, and nine points lower than the never or past smokers.

"Although the exact pathophysiological mechanism underlying the association between smoking status and angina after PCI is unknown, it is congruent with basic science studies that demonstrate correlations between smoking and vascular reactivity, oxidative stress, endothelial damage, endothelial vasomotor dysfunction, platelet aggregation, and adhesion," the authors wrote.

However, no causal relationship has been established. Even so, they wrote, sharing the findings from this study with patients may motivate them to quit smoking.

"The association of smoking and risk for (coronary heart disease) has been known for 50 years," said of Duke Clinical Research Institute in Durham, North Carolina, in email to Reuters Health.

Based on the new paper, smokers tend to need angioplasty at a significantly younger age, said Peterson, who coauthored an editorial accompanying the new study.

It would be logical for surgeons to require people with heart disease to quit smoking before angioplasty, but that is unlikely to happen, Spertus said.

"While in England, doctors may not offer revascularization to those who continue smoking, in the U.S. fee-for-service health care system, smoking status typically does not affect eligibility for treatment," Peterson said.

Some patients may be truly unable to quit, while others probably don't fully understand the importance of quitting, Dr. Spertus said.

"These patients are coming in and it's a very teachable moment to get patients to quit," he said.

"Combinations of patient education, behavioral therapy, cardiac rehabilitation, and certain drugs can make (quitting) easier," Peterson said. "Yet, often success is only achieved when the patients are referred to a smoking cessation specialist."

The American Heart Association and the National Heart, Lung, and Blood Institute supported this research. Spertus owns a copyright to the Seattle Angina Questionnaire used in the study.

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