Korean Circ J.  2016 Sep;46(5):632-638. 10.4070/kcj.2016.46.5.632.

Impact of Cigarette Smoking: a 3-Year Clinical Outcome of Vasospastic Angina Patients

• Choi BG
• Rha SW
• Park T
• Choi SY
• Byun JK
• Shim MS
• Xu S
• Li H
• Park SH
• Park JY
• Choi WG
• Cho YH
• Lee S
• Na JO
• Choi CU
• Lim HE
• Kim JW
• Kim EJ
• Park CG
• Seo HS
• Oh DJ

• KMID: 2389619
• DOI: http://doi.org/10.4070/kcj.2016.46.5.632

Abstract

BACKGROUND AND OBJECTIVES
Cigarette smoking is a risk significant factor in coronary artery disease (CAD) and vasospastic angina (VSA). However, it is largely unknown whether smoking adds to any long-term clinical risk in VSA patients.
SUBJECTS AND METHODS
A total of 2797 patients without significant CAD underwent acetylcholine (Ach) provocation test between November 2004 and October 2010. Patients were divided into three groups, based on the presence of coronary artery spasm (CAS) and smoking habits (non-CAS group: n=1188, non-smoking CAS group: n=1214, smoking CAS group: n=395). All CAS patients were prescribed with anti-anginal medications for at least 6 months. The incidence of major clinical outcomes and recurrent angina of these groups were compared up to 3 years.
RESULTS
There were considerable differences in the baseline clinical and angiographic characteristics among the three groups, but there was no difference in the endpoints among the three groups (including individual and composite hard endpoints) such as death, myocardial infarction, de novo percutaneous coronary intervention, cerebrovascular accident, and major adverse cardiac events. However, there was a higher incidence of recurrent angina in both the non-smoking CAS group and smoking CAS group, as compared to the non-CAS group. In multivariable adjusted Cox-proportional hazards regression analysis, smoking CAS group exhibited a higher incidence of recurrent angina compared with the non-CAS group (hazard ratio [HR]; 2.46, 95% confidence interval [CI]; 1.46-4.14, p=0.001) and non-smoking CAS group (HR; 1.76, 95% CI; 1.08-2.87, p=0.021).
CONCLUSION
Cigarette smoking CAS group exhibited higher incidence of recurrent angina during the 3-year clinical follow-up compared with both the non-CAS group and non-smoking CAS group. Quitting of smoking, paired with intensive medical therapy and close clinical follow-up, can help to prevent recurrent angina.

Keyword

Coronary artery spasm; Cigarette smoking; Clinical outcome

MeSH Terms

Acetylcholine
Coronary Artery Disease
Coronary Vessels
Follow-Up Studies
Humans
Incidence
Myocardial Infarction
Percutaneous Coronary Intervention
Smoke
Smoking*
Spasm
Stroke
Tobacco Products*
Acetylcholine
Smoke

Figure

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  Fig. 1 Flow chart.

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  Fig. 2 Survival curve analysis describing the cumulative incidences of recurrent angina at 3 years. (A) Kaplan-Meyer curve analysis showed that in comparison to the non-CAS group, both the non-smoking CAS patient group and smoking CAS patient group showed cumulatively higher incidences of recurrent angina. (B) multivariable Cox proportional hazards regression showed that the smoking CAS patient group had a higher rate of recurrent angina than the non-CAS group, with smoking being the only difference (HR; 2.46, 95% CI; 1.46-4.13, p=0.001). CAS-: non-coronary artery spasm patient group, CAS+/Sm-: non-smoking CAS patient group, CAS+/Sm+: cigarette smoking CAS patient group, P1: p value by CAS- vs. CAS+/Sm-, P2: p value of CAS- vs. CAS+/Sm+, P3: p value by CAS+/Sm- vs. CAS+/Sm+, CAS: coronary artery spasm, HR: hazard ratio, CI: confidence interval, Ach: acetylcholine.

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