3 research outputs found
Smoking determines the 10-year (2004–2014) prognosis in patients with Acute Coronary Syndrome: the GREECS observational study
Improved vascular healing after the successful treatment of very late sirolimus-eluting stent thrombosis with a bare metal stent implantation – A serial optical coherence tomography study
We present the case of a patient with non-ST-elevated myocardial infarction due to very late stent thrombosis 2 years after a sirolimus-eluting stent implantation (SES). Optical coherence tomography (OCT) imaging identified vessel wall destruction of the whole stented coronary segment with multiple cavity formations along the entire stent length, severe strut malapposition and thrombi. The patient was treated successfully with the implantation of a bare metal stent (BMS). Follow-up OCT imaging at 12 months revealed the improvement of vascular healing with complete re-endothelialization of the distal parts of the new BMS, while the stent body remained partly uncovered, suggesting vascular toxicity due to the old SES
Smoking determines the 10-year (2004–2014) prognosis in patients with Acute Coronary Syndrome: the GREECS observational study
Background
Smoking has long been positively associated with the development and progression of coronary heart
disease. However, longitudinal cohort studies evaluating smoking habits among cardiac patients as well as the role of
socio-demographic factors determining such behaviours are scarce and have been focused on primary care practice.
Thus the aim of the present work was to examine the association of active smoking and behaviours and exposure to
second-hand smoke, with the 10-year Acute Coronary Syndrome (ACS) prognosis, among cardiovascular patients.
Methods
From October 2003 to September 2004, a sample of six Greek hospitals was selected and almost
allconsecutive 2172 ACS patients were enrolled. In 2013–14, the 10-year follow-up was performed in 1918
participants (11 % loss to follow-up). Smoking habits at the time of entry to the study, as well as during the
follow-up period were studied using a standard questionnaire.
Results
Patients who had >60 pack-years of smoking had 57.8 % higher ACS mortality and 24.6 % higher risk for any
ACS event. Nested model, adjusted only for age and sex, revealed that for every 30 pack-years of smoking increase, the
associated ACS risk increased by 13 % (95 % CI 1.03, 1.30, p = 0.001). When further adjusted analysis, including several
potential confounders, was applied the tested relationship was still significant (95 %CI 1.03, 1.30, p = 0.09). Accordingly, the
risk for fatal ACS events increased by 8 % for every 30 pack-years of smoking increase (95 % CI 1.03, 1.63, p = 0.06).
Moreover, 52 % of the patients reported being exposed to secondhand smoke and when further adjustments were
made, it was revealed that they had 33 % (95 % CI 1.12, 1.60, p = 0.01) higher risk of having recurrent ACS events.
Conclusions
Active smoking and second-hand smoke among cardiac patients still represent a substantial clinical
burden. Thus, smoking cessation policies should be incorporated into the long-term therapeutic management