Association of smoking with restenosis and major adverse cardiac events after coronary stenting: A meta-analysis.

Bangli Hu

doi:10.12669/pjms.314.7495

Abstract

Background and Objective:The association between smoking and clinical outcomes after coronary stenting is controversial. The aim of this meta-analysis was to assess the association between smoking and in stent restenosis (ISR), major adverse cardiac events (MACE), or major adverse cardiac and cerebrovascular events (MACCE) after coronary stenting.Methods:A search for studies published before December 2014 was conducted in PubMed, Embase, and Cochrane library. An inverse random weighted meta-analysis was conducted using logarithm of the odds ratio (OR) and its standard error for each study.Results:Ten studies investigated the association between smoking and ISR. Overall, smoking was not associated with ISR (OR: 1.05, 95% CI: 0.79–1.41; I2 = 47.8%). Subgroup analysis also failed to show a significant association between smoking and ISR risk regardless of bare metal stent (BMS) and drug-eluting stent (DES) implantation. Eight studies explored the association between smoking and MACE, but no association was found (OR: 0.92, 95% CI: 0.77–1.10; I2 = 25.5%), and subgroup analysis revealed that no distinct difference was found between BMS and DES implantation. Three studies investigated the association between smoking and MACCE and significant association was found (OR: 2.09, 95% CI: 1.43–3.06; I2 = 21.6%).Conclusions:Our results suggest that in patients undergoing percutaneous coronary intervention with stent implantation, smoking is not associated with ISR and MACE; however, smoking is an independent risk factor for MACCE.

Highlights

Findings of previous studies strongly suggest that cigarette smoking is a preventable risk factor for coronary artery disease (CAD) and is strongly associated with cardiovascular-related morbidity and mortality
Inclusion and exclusion criteria: The identified studies met the following criteria: (1) The study design was an observational study in human beings; (2) the study investigated the association between smoking and in stent restenosis (ISR) and major adverse cardiac events (MACE) after stent implantation; (3) the study provided data about the effect of smoking on ISR or MACE from multivariate analysis; (4) ISR was defined as ≥50% diameter stenosis of the culprit lesion by quantitative coronary analysis; and (5) the duration of follow-up was at least 6 months
Smoking and ISR: Generally, cigarette smoking is considered to be associated with CAD progression and restenosis following angioplasty because of its effects on endothelial and platelet function

Summary

INTRODUCTION

Findings of previous studies strongly suggest that cigarette smoking is a preventable risk factor for coronary artery disease (CAD) and is strongly associated with cardiovascular-related morbidity and mortality. There are paradoxical results about the effect of smoking on clinical outcomes after PCI, such as in stent restenosis (ISR),[5,6] major adverse cardiac events (MACE), and major adverse cardiac and cerebrovascular events (MACCE).[7,8] The inconsistent results were generally caused by factors such as different baseline characteristics of patients and small sample size; to determine the impact of smoking on ISR and MACE after coronary stenting, we conducted a metaanalysis by incorporating adjustments for relevant confounding factors

METHODS

Findings

DISCUSSION