Skip to main content
PMC home page
Heart logoLink to Heart
. 2000 Sep;84(3):299–306. doi: 10.1136/heart.84.3.299

Influence of a history of smoking on short term (six month) clinical and angiographic outcome after successful coronary angioplasty

A Violaris 1, A Thury 1, E Regar 1, R Melkert 1, P Serruys 1
PMCID: PMC1760957  PMID: 10956296

Abstract

OBJECTIVES—To assess the influence of smoking on restenosis after coronary angioplasty.
DESIGN AND PATIENTS—The incidence of smoking on restenosis was investigated in 2948 patients. They were prospectively enrolled in four major restenosis trials in which quantitative angiography was used before and immediately after successful angioplasty and again at six months.
RESULTS—Within the study population there were 530 current smokers, 1690 ex-smokers, and 728 non-smokers. Smokers were more likely to be men (85.9% v 87.5% v 65.3%, current v ex- v non-, p < 0.001), to be younger (54.0 (9.0) v 57.0 (9.1) v 59.9 (9.4) years, p < 0.001), to have peripheral vascular disease (7.2% v 5.5% v 2.3%, p < 0.001), and have sustained a previous myocardial infarction (42.9% v 43.9% v 37.9%, p = 0.022), but were less likely to be diabetic (9.1% v 9.5% v 12.6%, p = 0.043) or hypertensive (24.9% v 29.3% v 37.2, p < 0.001). There was no significant difference in the categorical restenosis rate (> 50% diameter stenosis) at six months (35.28% v 35.33% v 37.09%, current v ex- v non-), or the absolute loss (0.29 (0.54) v 0.33 (0.52) v 0.35 (0.55) mm, respectively; p = 0.172).
CONCLUSIONS—Although smokers have a lower incidence of known predisposing risk factors for atherosclerosis, they require coronary intervention almost six years earlier than non-smokers and three years earlier than ex-smokers. Once they undergo successful coronary angioplasty, there appears to be no evidence that smoking influences their short term (six month) outcome, but because of the known long term effects of smoking, patients should still be encouraged to discontinue the habit.


Keywords: coronary angioplasty; smoking; restenosis; quantitative angiography

Full Text

The Full Text of this article is available as a PDF (155.5 KB).

Figure 1  .

Figure 1  

Open in a new tab

Cumulative distribution curve of clinical end points over time for current smokers, ex-smokers, and non-smokers.

Figure 2  .

Figure 2  

Open in a new tab

(A) Cumulative distribution curve of minimum lumen diameter before and after PTCA and at follow up, for current smokers, ex-smokers, and non-smokers. (B) Cumulative distribution curve of percentage stenosis before and after PTCA and at follow up for current smokers, ex-smokers, and non-smokers.

Figure 3  .

Figure 3  

Open in a new tab

(A) Cumulative distribution curve of absolute loss for current smokers, ex-smokers, and non-smokers. (B) Cumulative distribution curve of relative loss for current smokers, ex-smokers, and non-smokers.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allen R. A., Kluft C., Brommer E. J. Effect of chronic smoking on fibrinolysis. Arteriosclerosis. 1985 Sep-Oct;5(5):443–450. doi: 10.1161/01.atv.5.5.443. [DOI] [PubMed] [Google Scholar]
  2. Asakura Y., Suzuki M., Nonogi H., Haze K., Sato A., Inada H., Okuda Y., Yamashita K., Harano Y. Restenosis after percutaneous transluminal coronary angioplasty in patients with non-insulin-dependent diabetes mellitus (NIDDM). J Cardiovasc Risk. 1998 Oct-Dec;5(5-6):331–334. [PubMed] [Google Scholar]
  3. Badimon L., Badimon J. J. Mechanisms of arterial thrombosis in nonparallel streamlines: platelet thrombi grow on the apex of stenotic severely injured vessel wall. Experimental study in the pig model. J Clin Invest. 1989 Oct;84(4):1134–1144. doi: 10.1172/JCI114277. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Barbash G. I., White H. D., Modan M., Diaz R., Hampton J. R., Heikkila J., Kristinsson A., Moulopoulos S., Paolasso E. A., Van der Werf T. Significance of smoking in patients receiving thrombolytic therapy for acute myocardial infarction. Experience gleaned from the International Tissue Plasminogen Activator/Streptokinase Mortality Trial. Circulation. 1993 Jan;87(1):53–58. doi: 10.1161/01.cir.87.1.53. [DOI] [PubMed] [Google Scholar]
  5. Benowitz N. L. Drug therapy. Pharmacologic aspects of cigarette smoking and nicotine addition. N Engl J Med. 1988 Nov 17;319(20):1318–1330. doi: 10.1056/NEJM198811173192005. [DOI] [PubMed] [Google Scholar]
  6. Davis J. W., Hartman C. R., Lewis H. D., Jr, Shelton L., Eigenberg D. A., Hassanein K. M., Hignite C. E., Ruttinger H. A. Cigarette smoking--induced enhancement of platelet function: lack of prevention by aspirin in men with coronary artery disease. J Lab Clin Med. 1985 Apr;105(4):479–483. [PubMed] [Google Scholar]
  7. Doll R., Peto R. Mortality in relation to smoking: 20 years' observations on male British doctors. Br Med J. 1976 Dec 25;2(6051):1525–1536. doi: 10.1136/bmj.2.6051.1525. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Ernst E., Koenig W., Matrai A., Filipiak B., Stieber J. Blood rheology in healthy cigarette smokers. Results from the MONICA project, Augsburg. Arteriosclerosis. 1988 Jul-Aug;8(4):385–388. doi: 10.1161/01.atv.8.4.385. [DOI] [PubMed] [Google Scholar]
  9. Faxon D. P. Effect of high dose angiotensin-converting enzyme inhibition on restenosis: final results of the MARCATOR Study, a multicenter, double-blind, placebo-controlled trial of cilazapril. The Multicenter American Research Trial With Cilazapril After Angioplasty to Prevent Transluminal Coronary Obstruction and Restenosis (MARCATOR) Study Group. J Am Coll Cardiol. 1995 Feb;25(2):362–369. doi: 10.1016/0735-1097(94)00368-z. [DOI] [PubMed] [Google Scholar]
  10. Foley D. P., Melkert R., Serruys P. W. Influence of coronary vessel size on renarrowing process and late angiographic outcome after successful balloon angioplasty. Circulation. 1994 Sep;90(3):1239–1251. doi: 10.1161/01.cir.90.3.1239. [DOI] [PubMed] [Google Scholar]
  11. Friedman G. D., Siegelaub A. B., Seltzer C. C., Feldman R., Collen M. F. Smoking habits and the leukocyte count. Arch Environ Health. 1973 Mar;26(3):137–143. doi: 10.1080/00039896.1973.10666241. [DOI] [PubMed] [Google Scholar]
  12. Galan K. M., Deligonul U., Kern M. J., Chaitman B. R., Vandormael M. G. Increased frequency of restenosis in patients continuing to smoke cigarettes after percutaneous transluminal coronary angioplasty. Am J Cardiol. 1988 Feb 1;61(4):260–263. doi: 10.1016/0002-9149(88)90927-7. [DOI] [PubMed] [Google Scholar]
  13. Galea G., Davidson R. J. Haematological and haemorheological changes associated with cigarette smoking. J Clin Pathol. 1985 Sep;38(9):978–984. doi: 10.1136/jcp.38.9.978. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Hallstrom A. P., Cobb L. A., Ray R. Smoking as a risk factor for recurrence of sudden cardiac arrest. N Engl J Med. 1986 Jan 30;314(5):271–275. doi: 10.1056/NEJM198601303140502. [DOI] [PubMed] [Google Scholar]
  15. Hong M. K., Mehran R., Mintz G. S., Leon M. B. Restenosis after coronary angioplasty. Curr Probl Cardiol. 1997 Jan;22(1):1–36. doi: 10.1016/s0146-2806(97)80006-0. [DOI] [PubMed] [Google Scholar]
  16. Knoke J. D., Hunninghake D. B., Heiss G. Physiological markers of smoking and their relation to coronary heart disease. The Lipid Research Clinics Coronary Primary Prevention Trial. Arteriosclerosis. 1987 Sep-Oct;7(5):477–482. doi: 10.1161/01.atv.7.5.477. [DOI] [PubMed] [Google Scholar]
  17. Kotamäki M., Laustiola K., Syvänne M., Heikkilä J. Influence of continued smoking and some biological risk factors on restenosis after percutaneous transluminal coronary angioplasty. J Intern Med. 1996 Nov;240(5):293–301. doi: 10.1046/j.1365-2796.1996.26863000.x. [DOI] [PubMed] [Google Scholar]
  18. Kuntz R. E., Baim D. S. Defining coronary restenosis. Newer clinical and angiographic paradigms. Circulation. 1993 Sep;88(3):1310–1323. doi: 10.1161/01.cir.88.3.1310. [DOI] [PubMed] [Google Scholar]
  19. Macdonald R. G., Henderson M. A., Hirshfeld J. W., Jr, Goldberg S. H., Bass T., Vetrovec G., Cowley M., Taussig A., Whitworth H., Margolis J. R. Patient-related variables and restenosis after percutaneous transluminal coronary angioplasty--a report from the M-HEART Group. Am J Cardiol. 1990 Oct 15;66(12):926–931. doi: 10.1016/0002-9149(90)90927-s. [DOI] [PubMed] [Google Scholar]
  20. Mintz G. S., Kent K. M., Pichard A. D., Popma J. J., Satler L. F., Leon M. B. Intravascular ultrasound insights into mechanisms of stenosis formation and restenosis. Cardiol Clin. 1997 Feb;15(1):17–29. doi: 10.1016/s0733-8651(05)70315-5. [DOI] [PubMed] [Google Scholar]
  21. Myler R. K., Topol E. J., Shaw R. E., Stertzer S. H., Clark D. A., Fishman J., Murphy M. C. Multiple vessel coronary angioplasty: classification, results, and patterns of restenosis in 494 consecutive patients. Cathet Cardiovasc Diagn. 1987 Jan-Feb;13(1):1–15. doi: 10.1002/ccd.1810130102. [DOI] [PubMed] [Google Scholar]
  22. Nadler J. L., Velasco J. S., Horton R. Cigarette smoking inhibits prostacyclin formation. Lancet. 1983 Jun 4;1(8336):1248–1250. doi: 10.1016/s0140-6736(83)92698-3. [DOI] [PubMed] [Google Scholar]
  23. Quillen J. E., Rossen J. D., Oskarsson H. J., Minor R. L., Jr, Lopez A. G., Winniford M. D. Acute effect of cigarette smoking on the coronary circulation: constriction of epicardial and resistance vessels. J Am Coll Cardiol. 1993 Sep;22(3):642–647. doi: 10.1016/0735-1097(93)90170-6. [DOI] [PubMed] [Google Scholar]
  24. Ribeiro P., Jadhav A. V., Walesby R., Trayner I., Edmondson S., Oakley C. M., Thompson G. R. Collagen content of atherosclerotic arteries is higher in smokers than in non-smokers. Lancet. 1983 May 14;1(8333):1070–1073. doi: 10.1016/s0140-6736(83)91909-8. [DOI] [PubMed] [Google Scholar]
  25. Salerno D. M., Granrud G., Sharkey P., Asinger R., Hodges M. A controlled trial of propafenone for treatment of frequent and repetitive ventricular premature complexes. Am J Cardiol. 1984 Jan 1;53(1):77–83. doi: 10.1016/0002-9149(84)90687-8. [DOI] [PubMed] [Google Scholar]
  26. Schumacher M., Eber B., Tiran A., Toplak H., Luha O., Gasser R., Klein W. Fibrinogen values in patients with and without restenosis following percutaneous transluminal coronary angiography. Cardiology. 1992;80(5-6):345–348. doi: 10.1159/000175024. [DOI] [PubMed] [Google Scholar]
  27. Serruys P. W., Foley D. P., de Feyter P. J. Restenosis after coronary angioplasty: a proposal of new comparative approaches based on quantitative angiography. Br Heart J. 1992 Oct;68(4):417–424. doi: 10.1136/hrt.68.10.417. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Serruys P. W., Klein W., Tijssen J. P., Rutsch W., Heyndrickx G. R., Emanuelsson H., Ball S. G., Decoster O., Schroeder E., Liberman H. Evaluation of ketanserin in the prevention of restenosis after percutaneous transluminal coronary angioplasty. A multicenter randomized double-blind placebo-controlled trial. Circulation. 1993 Oct;88(4 Pt 1):1588–1601. doi: 10.1161/01.cir.88.4.1588. [DOI] [PubMed] [Google Scholar]
  29. Serruys P. W., Luijten H. E., Beatt K. J., Geuskens R., de Feyter P. J., van den Brand M., Reiber J. H., ten Katen H. J., van Es G. A., Hugenholtz P. G. Incidence of restenosis after successful coronary angioplasty: a time-related phenomenon. A quantitative angiographic study in 342 consecutive patients at 1, 2, 3, and 4 months. Circulation. 1988 Feb;77(2):361–371. doi: 10.1161/01.cir.77.2.361. [DOI] [PubMed] [Google Scholar]
  30. Serruys P. W., Rutsch W., Heyndrickx G. R., Danchin N., Mast E. G., Wijns W., Rensing B. J., Vos J., Stibbe J. Prevention of restenosis after percutaneous transluminal coronary angioplasty with thromboxane A2-receptor blockade. A randomized, double-blind, placebo-controlled trial. Coronary Artery Restenosis Prevention on Repeated Thromboxane-Antagonism Study (CARPORT). Circulation. 1991 Oct;84(4):1568–1580. doi: 10.1161/01.cir.84.4.1568. [DOI] [PubMed] [Google Scholar]
  31. Sugrue D. D., Thompson G. R., Oakley C. M., Trayner I. M., Steiner R. E. Contrasting patterns of coronary atherosclerosis in normocholesterolaemic smokers and patients with familial hypercholesterolaemia. Br Med J (Clin Res Ed) 1981 Nov 21;283(6303):1358–1360. doi: 10.1136/bmj.283.6303.1358. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Vandormael M. G., Deligonul U., Kern M. J., Harper M., Presant S., Gibson P., Galan K., Chaitman B. R. Multilesion coronary angioplasty: clinical and angiographic follow-up. J Am Coll Cardiol. 1987 Aug;10(2):246–252. doi: 10.1016/s0735-1097(87)80003-7. [DOI] [PubMed] [Google Scholar]
  33. de Chillou C., Riff P., Sadoul N., Ethevenot G., Feldmann L., Isaaz K., Simon J. P., Boursier M., Khalifé K., Thisse J. Y. Influence of cigarette smoking on rate of reopening of the infarct-related coronary artery after myocardial infarction: a multivariate analysis. J Am Coll Cardiol. 1996 Jun;27(7):1662–1668. doi: 10.1016/0735-1097(96)00091-5. [DOI] [PubMed] [Google Scholar]

Articles from Heart are provided here courtesy of BMJ Publishing Group

RESOURCES