The Impact of Aversive Advice During Percutaneous Coronary Intervention on Smoking Cessation in Patients With Acute Coronary Syndrome

Abstract

BackgroundSmoking cessation is important to prevent recurrence of acute coronary syndrome (ACS), but even in patients with ACS, smoking is hard to quit. ObjectivesThis study hypothesized that aversive advice during the percutaneous coronary intervention (PCI) procedure works effectively to promote smoking cessation in patients with ACS. MethodsThis study was conducted as a prospective, single-blinded, randomized controlled trial. A total of 66 patients were randomly assigned to an aversive advice group or a control group and instructed to visit the outpatient clinic 1, 4, and 24 weeks after discharge. In the aversive advice group, a physician who did not participate in the patient follow-up said the following 3 sentences to the patients during the PCI procedure: “Smoking caused your chest pain”; “If you do not stop smoking right now, this pain will come again”; and “The next time you feel this pain you will probably die.” All patients received usual advice on the importance of quitting smoking. ResultsAt 24 weeks after discharge, the smoking cessation rate was higher in the aversive advice group than in the control group. In a multivariable logistic regression analysis, after adjustment for age, smoking quantity, alcohol consumption, and disease severity, the result was maintained (odds ratio = 4.47, 95% confidence interval: 1.50 to 13.34). ConclusionsAversive advice during a PCI procedure is effective at smoking cessation in patients with ACS. A physician's attention and involvement during the PCI procedure improves the rate of smoking cessation in patients with ACS.