After Transplantation Nearly Smoking On Coronary Artery Bypass, Long-term Results Of Impact Studies

Part one: Effect of Smoking on Early Outcome of Patients Undergoing Coronary Artery Bypass SurgeryObjective:To assess the influence of smoking on early outcome in patients undergoing coronary artery bypass graft surgery (CABG).Methods:We retrospectively analyze2570consecutive patients underwent CABG in Fuwai hospital from January2004to December2005. Of these,1457patients were smokers in which1029patients were current smokers,409were former smokers who stopped smoking more than1month, and1029were nonsmokers. Assess the in-hospital morbidity and mortality of current smokers and former smokers compared with nonsmokers undergoing CABG.Results:Smokers were more likely to be younger (P<0.001), Smokers had higher rates of postoperative pulmonary complications (3.2%vs1.6%, p=0.010) and longer ventilation time was longer (.P=0.016) than nonsmokers. Former smokers had no elevated risks for pulmonary complications or longer ventilation time compared with nonsmokers. The odds ratio (OR) for developing a postoperative pulmonary complication for current smokers vs never smokers was1.91(95%CI,1.03-3.56) after adjustment for age, history of congestive heart failure, history of COPD and so on. And current smokers had longer ventilation time was longer (P=0.026) than nonsmokers Rates of low cardiac output, myocardial infarction, atrial fibrillation, heart arrest/wentricular fibrillation postoperative length of stay in intensive care unit, other postoperative complications, and mortality did not differ between former smokers and nonsmokers.Conclusions:Smoking especially current smoking are associated with significant pulmonary complications and longer ventilation time after CABG, Morbidity and mortality are comparable between former smokers and nonsmokers. Smokers should be encouraged to quit as early as possible, and smoking cessation of1month before CABG was beneficial. Part two: Long-term effects of smoking on patients after coronary artery bypass graft surgery.Objective:The goal of this study was to determine effect of smoking behaviors on long-term outcomes of coronary artery bypass graft surgery (CABG) and effect of different smoking consumption on long-term outcomes of coronary artery bypass graft surgery.Methods:We conduct a survey of2541consecutive patients who underwent CABG in Fuwai hospital, The preoperative and postoperative smoking habits were retrieved, the patients were divided into two groups:never smokers and ever smokers; the ever smokers was further divided into the following groups:persistent smokers who smoked before and after CABG, former smokers who stopped smoking before CABG, quitters who stopped smoking after CABG, and never smokers, the persistent smokers was divided into the following groups:persistent smokers<10cigarettes per day and persistent smokers≥10cigarettes per day, analyzed the morbidity and mortality in univariate and multivariate Cox analysis.Results:The median follow-up was5.09years, the overall response rate was96.7%, in analyses adjusted for baseline characteristics, ever smokers had more elevated relative risk (RR)for tumor related death (RR2.38,95%confidence interval, CI,1.06-5.36), MACCE(RR1.26,95%CI,1.01-1.57) and angina pectoris(RR1.29,95%CI,1.04-1.59) compared with never smokers. The persistent smokers had a greater relative risk of death from all causes (RR2.60,95%CI,1.53-4.46), cardiac death (RR2.51,95%CI,1.32-4.78), tumor related death (RR5.12,95%CI,2.08-12.59), MACCE(RR1.83,95%CI,1.42-2.34) and angina pectoris(RR1.69,95%CI,1.33-2.16) as compared with never smokers. No differences in outcome were found among patients who stopped smoking and never smokers. As compared with never smokers, persistent smokers<10cigarettes per day had a greater relative risk of death from all causes (RR2.48,95%CI,1.31-4.69), cardiac death (RR2.41,95%CI,1.12-5.17), tumor related death (RR5.06,95%CI,1.87-14.23), MACCE (RR1.77,95%CI,1.31-2.39)and angina pectoris(RR1.41,95%CI,1.05-1.91). persistent smokers≥10cigarettes per day had a greater relative risk of death from all causes (RR2.76,95%CI,1.43-5.32), cardiac death (RR2.62,95%CI,1.22-5.64), tumor related death (RR4.93,95%CI,1.64-14.85),MACCE(RR1.90,95%CI,1.39-2.60)and angina pectoris(RR2.07,95%CI,1.52-2.84). Analysis did not reveal significant differences in all causes (RR0.90,95%CI0.44-1.85), cardiac death (RR0.92,95%CI0.40-2.10), tumor related death (RR1.07,95%CI0.37-3.10), and MACCE(RR0.93,95%CI0.65-1.33) but lower incidence of angina pectoris (RR0.68;95%CI:0.47-0.98) between the persistent smokers smoked<10cigarettes per day and those smoked≥10cigarettes per day.Conclusions:Smoking prevalence was still high in patients after CABG in china(22.1%), persistent smoking is associated with higher rates of mortality and morbidity after CABG, smoking cession was associated with reduction of morbidity and mortality. Reduction of smoking daily consumption was not associated with reduction of morbidity and mortality...