Effect of smoking cessation and surgical revascularization results after coronary artery bypass

Yıl 2021, Cilt: 12 Sayı: 2, 211 - 216, 30.06.2021

Sertan Özyalçın

https://doi.org/10.18663/tjcl.938784

Öz

Aim: Studies on the effect of post-operative smoking on patients undergoing coronary artery bypass grafting surgery (CABG) contain very few and limited results. In this study, it is aimed to reveal the effect of smoking after CABG on major cardiac events and cerebrovascular events in the postoperative period.
Materials and Methods: A total of 551 patients who had an isolated CABG operation in the Hitit University Cardiovascular Surgery Clinic between January 2016 and December 2020 and who smoked before the operation were examined in the study. The patients were divided into two groups as those who stopped smoking after the CABG operation and those who continued to smoke. The mean age of the patients was 62.1 ± 11.0 years. In the preoperative period, 551 of these patients (75.1%) were active smokers. In the preoperative period, 291 (52.8%) of the smoking patients were male and 260 (47.2%) were female. The endpoints of the study were considered as postoperative major cardiac events and cerebrovascular events. The survival rates of the patients in terms of major cardiac events and cerebrovascular events were examined using Kaplan-Meier analysis.


Results: It was observed that 137 (24.7%) of 551 patients who actively smoked in the preoperative period continued to smoke after the operation. It was found that the smoking cessation rate of the patients did not differ between men and women. When the patients were evaluated by Kaplan-Meier analysis, the survival in terms of major 300-day cardiac events was 92.6% in patients who quit smoking, while it was 71.6% in patients who continued to smoke (p <0.001). The survival in terms of 300-day cerebrobvascular events in patients who quit smoking was 98.9%, while it was 83.2% in patients who continued to smoke (p <0.001).
Conclusion: Our study shows that smoking cessation of patients after CABG operation reduces the possibility of major cardiac events and cerebrovascular events developing after the operation. As a result, smoking must be terminated after CABG operation in smoking patients; For this purpose, patients who do not or cannot quit smoking should be followed up in this regard and should be enabled to participate in smoking cessation programs.

Anahtar Kelimeler

coronary, bypass, smoking, revascularization

Koroner arter baypas sonrası sigarayı bırakma ve cerrahi revaskülarizasyonun sonuçları

Öz

Amaç: Koroner arter baypas greftleme ameliyatı (KABG) geçiren hastalarda, operasyon sonrası sigara içiminin etkisi hakkında yapılan çalışmalar oldukça az sayıda ve kısıtlı sonuçlar içermektedir. Bu çalışmada, KABG operasyonu sonrası sigara içiminin, operasyon sonrası dönemde majör kardiyak olaylar ve serebrovasküler olaylar üzerindeki etkisinin ortaya konması amaçlanmıştır.
Gereç ve Yöntemler: Çalışmada Ocak 2016 ve Aralık 2020 tarihleri arasında Hitit Üniversitesi Kalp ve Damar Cerrahisi Kliniğinde izole KABG operasyonu geçiren ve operasyon öncesi dönemde sigara içen toplam 551 hasta incelendi. Hastalar, KABG'den operasyonundan sonra sigarayı içmeyi bırakanlar ve sigara içmeye devam edenler olarak iki gruba ayrıldı. Hastaların yaş ortalaması 62.1±11.0 yıl idi. Preoperatif dönemde bu hastaların 551(%75,1) tanesinin aktif sigara içicisi idi. Preoperatif dönemde sigara içen hastaların 291’i(%52,8) erkek, 260’ı(%47,2) kadın cinsiyette idi. Çalışmanın sonlanım noktaları operasyon sonrası majör kardiyak olaylar ve serebrovasküler olaylar olarak ele alındı. Kaplan- Meier analizi kullanılarak hastaların majör kardiyak olaylar ve serebrovasküler olaylar açısından sağkalım oranları incelendi.
Bulgular: Preoperatif dönemde aktif sigara içen 551 hastanın, operasyon sonrası 137’si (%24,7) sigara içmeye devam ettiği gözlendi. Hastaların sigara bırakma oranı kadın ve erkek cinsiyette farklılık göstermediği tespit edildi. Hastalar Kaplan-Meier analizi ile değerlendirildiğinde, sigara içimini bırakan hastalarda 300 günlük majör kardiyak olaylar açısından sağkalım %92,6 iken sigara içmeye devam eden hastalarda sağkalım %71,6 olarak tespit edildi (p<0.001). Sigara içimini bırakan hastalarda 300 günlük serebrobvasküler olaylar açısından sağkalım ise %98.9 iken sigara içmeye devam eden hastalarda sağkalım %83.2 olarak tespit edildi (p<0.001).
Sonuç: Çalışmamız, KABG operasyonundan sonra hastaların sigara içiminin sonlandırılmasının, operasyon sonrası gelişen majör kardiyak olay ve serebrovasküler olay gelişimi olasılığını ileri seviyede azalttığını göstermektedir. Sonuç olarak sigara içen hastalarda KABG operasyonundan sonra mutlaka sigara içiminin sonlandırılması; bu amaçla sigara içimini bırakmayan veya bırakamayan hastaların bu konuda takip edilerek, sigara bırakma programlarına katılması sağlanmalıdır.

Anahtar Kelimeler

koroner, baypas, sigara, revaskülarizasyon, revaskülarizasyon

Kaynakça

• 1. Ford ES, Ajani UA, Croft JB, Critchley JA, Labarthe DR, Kottke TE, Giles WH, Capewell S. Explaining the decrease in U.S. deaths from coronary disease, 1980-2000. N Engl J Med 2007; 356: 2388-98.
• 2. Cohen DJ, Doucet M, Cutlip DE, Ho KK, Popma JJ, Kuntz RE. Impact of smoking on clinical and angiographic restenosis after percutaneous coronary intervention: another smoker's paradox? Circulation 2001; 104: 773-8.
• 3. Weisz G, Cox DA, Garcia E et al. Impact of smoking status on outcomes of primary coronary intervention for acute myocardial infarction--the smoker's paradox revisited. Am Heart J 2005; 150: 358-64.
• 4. Kinjo K, Sato H, Sakata Y et al. Acute Coronary Insufficiency Study G. Impact of smoking status on long-term mortality in patients with acute myocardial infarction. Circ J 2005; 69: 7-12.
• 5. Wilson K, Gibson N, Willan A, Cook D. Effect of smoking cessation on mortality after myocardial infarction: meta-analysis of cohort studies. Arch Intern Med 2000; 160: 939-44.
• 6. Ji Q, Zhao H, Mei Y, Shi Y, Ma R, Ding W. Impact of smoking on early clinical outcomes in patients undergoing coronary artery bypass grafting surgery. J Cardiothorac Surg 2015; 10: 16.
• 7. Rigotti NA, McKool KM, Shiffman S. Predictors of smoking cessation after coronary artery bypass graft surgery. Results of a randomized trial with 5-year follow-up. Ann Intern Med 1994; 120: 287-93.
• 8. Al-Sarraf N, Thalib L, Hughes A, Tolan M, Young V, McGovern E. Effect of smoking on short-term outcome of patients undergoing coronary artery bypass surgery. Ann Thorac Surg 2008; 86: 517-23.
• 9. Saxena A, Shan L, Reid C, Dinh DT, Smith JA, Shardey GC, Newcomb AE. Impact of smoking status on early and late outcomes after isolated coronary artery bypass graft surgery. J Cardiol 2013; 61: 336-41.
• 10. Benedetto U, Albanese A, Kattach H et al. Cardiac Outcomes Research G. Smoking cessation before coronary artery bypass grafting improves operative outcomes. J Thorac Cardiovasc Surg 2014; 148: 468-74.
• 11. van Domburg RT, op Reimer WS, Hoeks SE, Kappetein AP, Bogers AJ. Three life-years gained from smoking cessation after coronary artery bypass surgery: a 30-year follow-up study. Am Heart J 2008; 156: 473-6.
• 12. Violaris AG, Thury A, Regar E, Melkert R, Serruys PW. Influence of a history of smoking on short term (six month) clinical and angiographic outcome after successful coronary angioplasty. Heart 2000; 84: 299-306.
• 13. Cavender JB, Rogers WJ, Fisher LD, Gersh BJ, Coggin CJ, Myers WO. Effects of smoking on survival and morbidity in patients randomized to medical or surgical therapy in the Coronary Artery Surgery Study (CASS): 10-year follow-up. CASS Investigators. J Am Coll Cardiol 1992; 20: 287-94.
• 14. Papathanasiou A, Milionis H, Toumpoulis I, Kalantzi K, Katsouras C, Pappas K, Michalis L, Goudevenos J. Smoking cessation is associated with reduced long-term mortality and the need for repeat interventions after coronary artery bypass grafting. Eur J Cardiovasc Prev Rehabil 2007; 14: 448- 50.
• 15. van Domburg RT, Meeter K, van Berkel DF, Veldkamp RF, van Herwerden LA, Bogers AJ. Smoking cessation reduces mortality after coronary artery bypass surgery: a 20-year follow-up study. J Am Coll Cardiol 2000; 36: 878-83.
• 16. Rigotti NA, Clair C. Managing tobacco use: the neglected cardiovascular disease risk factor. Eur Heart J 2013; 34: 3259-67.
• 17. Ebbert JO, Hughes JR, West RJ, Rennard SI, Russ C, McRae TD, Treadow J, Yu CR, Dutro MP, Park PW. Effect of varenicline on smoking cessation through smoking reduction: a randomized clinical trial. JAMA 2015; 313: 687-94.
• 18. Eisenberg MJ, Grandi SM, Gervais A et al. Bupropion for smoking cessation in patients hospitalized with acute myocardial infarction: a randomized, placebo-controlled trial. J Am Coll Cardiol 2013; 61: 524-32.
• 19. Stead LF, Koilpillai P, Fanshawe TR, Lancaster T. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database Syst Rev 2016; 3: 8286.
• 20. Lindsay GM, Tolmie EP, Martin WM, Hutton IM, Belcher PR. Smoking after coronary artery bypass: high three-year mortality. Thorac Cardiovasc Surg 2009; 57: 135-40.