Effect of smoking status and abciximab use on outcome after percutaneous coronary revascularization: Pooled analysis from EPIC, EPILOG, and EPISTENT

Background: Tobacco use has been studied in relation to the development of atherosclerotic heart disease and outcome after acute coronary syndromes, though outcome data after percutaneous coronary intervention (PCI) are limited. Tobacco use has been associated with increased fibrinogen levels, thrombin generation, and increased platelet aggregation, and these factors may cause ischemic events after PCI. Methods: We assessed whether smokers undergoing PCI have more ischemic events and if glycoprotein IIb/IIIa receptor blockade is particularly beneficial in preventing ischemic events in this cohort. We examined clinical outcomes for smokers and nonsmokers by using pooled analysis from 3 large, placebo-controlled trials of the glycoprotein IIb/IIIa antagonist abciximab during PCI. Results: Among 6519 patients, 34% were smokers. The primary end point of death, myocardial infarction, or urgent revascularization within 30 days was reduced by abciximab from 12.3% to 6.4% (relative risk reduction, 48%; P < .001) in smokers and from 11.3% to 5.9% (relative risk reduction, 48%; P < .001) in nonsmokers treated with abciximab. At 6 months, death, myocardial infarction, or urgent revascularization was reduced from 14.4% to 8.5% (relative risk reduction, 41%; P < .001) in smokers and from 14.6% to 8.8% (relative risk reduction, 40%; P < .001) in nonsmokers. Adjusting for baseline differences, smoking was an independent predictor of poor outcome at 30 days (odds ratio, 1.22; 95% confidence interval, 1.02, 1.47; P = .03). Conclusions: This pooled analysis demonstrates that after PCI, smokers had worse 30-day outcomes than did nonsmokers. However, both groups had a comparable degree of benefit with platelet inhibition through the use of abciximab.