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Impact of smoking on all-cause mortality and cardiovascular events in patients after coronary revascularization with a percutaneous coronary intervention or coronary artery bypass graft

a systematic review and meta-analysis

Ma, Wen-Qia; Wang, Yinga; Sun, Xue-Jiaoa; Han, Xi-Qionga; Zhu, Yia; Yang, Ruib; Liu, Nai-Fenga

doi: 10.1097/MCA.0000000000000711
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Although cigarette smoking is an independent risk factor for cardiovascular disease, inconsistent results have been published in the literature on its impacts on the cardiovascular health of patients after coronary revascularization with a percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). We performed a comprehensive electronic database search through July 2018. Studies reporting the risk estimates of all-cause mortality and cardiovascular outcomes in patients after coronary revascularization with PCI or CABG on the basis of smoking status were selected. Multivariate-adjusted relative risks (RRs) and 95% confidence intervals (CIs) were pooled using random-effects models with inverse variance weighting. Data from 37 records including 126 901 participants were finally collected. Overall, the pooled RR (95% CI) associated with cigarette smoking was 1.26 (95% CI: 1.09–1.47) for all-cause mortality, 1.08 (95% CI: 0.92–1.28) for major adverse cardiovascular events, 0.96 (95% CI: 0.69–1.35) for cardiovascular mortality and 1.15 (95% CI: 0.81–1.64) for myocardial infarction. The increased risk of all-cause mortality was also observed in former smokers compared with those who had never smoked (RR: 1.19; 95% CI: 1.03–1.38). Furthermore, the negative effects of cigarette smoking on all-cause mortality were also observed in most subgroups. Cigarette smoking has been shown to increase the likelihood of all-cause mortality in patients after coronary revascularization with PCI or CABG. Smoking cessation is essential for PCI or CABG patients to manage their coronary artery disease.

aDepartment of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing

bDepartment of Pharmaceutical, Qianfoshan Hospital, Jinan, People’s Republic of China

Correspondence to Nai-Feng Liu, PhD, Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University 87 Dingjiaqiao, Nanjing 210009, People’s Republic China Tel: +86 025 8327 2002; fax: +86 025 8327 2369; e-mail: liunf@seu.edu.cn

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