Abstract 15491: Effects of Intensive Smoking Cessation Counseling After Acute Coronary Syndrome on 5-year Incidence of Major Adverse Cardiovascular Events and Smoking Abstinence

Abstract

Introduction: Smoking cessation is recommanded after an acute coronary syndrome (ACS). Long-term cardiovascular benefits of smoking cessation counseling during a hospitalization and shortly after discharge for an ACS remains unknown. We aimed to study the 5-year incidence of major adverse cardiovascular events (MACE, defined as cardiovascular death, myocardial infarction, stroke, unplanned coronary revascularization or hospitalization due to angina) and smoking abstinence after ACS, comparing usual care to an intensive smoking cessation counseling intervention in hospital and after discharge. Methods: We studied 951 smokers from the SPUM-ACS cohort hospitalized for ACS between 2009 and 2014 in a multicenter prospective study with information available at the 5-year follow-up visit on incident MACE. At baseline in 4 study centers, a non-randomized part of smokers with ACS received proactive in-hospital smoking cessation counseling along with several telephone counseling over a 2 months period after discharge. We compared this intensive counseling group to the usual care group, regarding the incidence of MACE at 5 years. We used a multivariate adjusted Cox-proportional hazards model to estimate hazard ratios (HR) and 95% confidence intervals (CI). The secondary outcome was smoking cessation rate 5 years post-ACS. Results: Out of 951 smokers with ACS, 228 (35%) received the intensive in-hospital smoking intervention, of which 186 (82%) accepted to receive counseling after discharge. After multivariable adjustment for age, sex, education and study site, the 5-year risk of a recurrent MACE was comparable between the intensive counseling group and the usual care group, with a multivariable HR of 1.02 (95% CI 0.71-1.46, p=0.92). Among 669 patients alive 5 years post-ACS with known smoking status, 95 (56%) had stopped smoking in the intensive counseling group and 234 (47%) in the usual care group, with a multivariate odds ratio of 0.69 (95% CI 0.47-1.03; p=0.07). Conclusions: In this observational study, an intensive smoking cessation intervention during hospitalization for ACS with post-discharge telephone counseling did not reduce 5-year recurrence of MACE. However, this early intervention may confer a benefit for long-term smoking abstinence.