Smokers versus non-smokers undergoing percutaneous transluminal coronary angioplasty: The impact of clinical and procedural characteristics on in-hospital mortality.

BACKGROUND: We aimed to compare clinical and procedural characteristics of unselected smokers and non-smokers undergoing percutaneous transluminal coronary angioplasty (PTCA) and to assess their impact on in-hospital mortality.
METHODS: One thousand consecutive patients treated interventionally were retrospectively enrolled into a single academic centre registry.
RESULTS: Smokers (n = 631), in comparison to non-smokers (n = 369), were younger and less likely to be hypertensive, diabetic and female gender. History of myocardial infarction and pre-existing heart failure were also less frequent in the group of smokers. Furthermore, univariate analysis revealed more frequent presentation with acute coronary syndromes (ACS), shorter overall duration of PTCA, shorter exposure to X-rays and lower volume of contrast medium administered in smokers than in non-smokers. Conversely, non-smokers were characterized by considerably higher prevalence of multivessel disease, lower completeness of revascularization and worse final epicardial flow in primary PTCA procedures. Moreover, non-smokers experienced higher crude in-hospital mortality than smokers in the setting of unstable angina/non-ST-segment elevation myocardial infarction (0.0% vs. 6.0%, p = 0.0544) and ST-segment elevation myocardial infarction (6.0% vs. 14.0%, p < 0.02). Smoking status, when adjusted for the baseline characteristics, did not possess any predictive value in terms of in-hospital mortality and surrogates of intervention complexity.
CONCLUSIONS: A strong trend towards decreased mortality among smokers undergoing PTCA was observed when compared to non-smokers. However, the survival advantage might be fully explained by the younger age of the smokers, their more favourable clinical characteristics and less extensive coronary atherosclerosis. (Cardiol J 2007; 14: 482-492).