Can I Smoke Again After Dr
The agin effects of smoking on coronary artery affliction have been well described in the past. Previous studies showed that smoking is strongly related to the progression of coronary artery disease1 ii 3 too as to the incidence of cardiac deathfour v and myocardial infarction.half dozen seven 8 9 Other studies showed improved survival10 xi 12 thirteen fourteen and a lower incidence of myocardial infarctionfifteen 16 later on smoking abeyance. Because of these results and the nowadays restricted resources, in that location has been controversy recently well-nigh whether smokers should accept the same opportunities for coronary bypass surgery every bit nonsmokers.17 xviii However, effects of smoking and smoking cessation after coronary bypass surgery on the need for reoperation and coronary angioplasty and on the return of angina pectoris have non been well described.
To make up one's mind the influence of smoking and smoking cessation not only on the incidence of death and myocardial infarction but also on reintervention and angina pectoris, we analyzed a group of 446 consecutive patients who underwent venous coronary featherbed surgery in 1976 or 1977 and were followed up prospectively for fifteen years.
Methods
Patients
A series of 446 consecutive patients underwent isolated aortocoronary saphenous vein featherbed surgery with or without resection of a left ventricular aneurysm at St Antonius Hospital, formerly in Utrecht and now in Nieuwegein, Netherlands, between April 1, 1976, and April 1, 1977. Eighteen patients in whom the performance was combined with a valve replacement were excluded from analysis. Thirteen patients died within 30 days afterwards the process. The study group of the 415 remaining patients consisted of 372 men and 43 women with a mean age of 52.five years (range, xx to 73 years). Other characteristics of the smokers and nonsmokers at baseline are presented in Table 1.
Follow-up and Information Collection
Several follow-upwardly methodologies were used simultaneously to obtain the nearly consummate information possible. All patients were followed up by use of the anniversary method at our outpatient clinic or the outpatient clinic of the referring cardiologists. All patients except one, who went abroad and was lost to follow-up 7 years afterward surgery, were traced at the common endmost date of April one, 1992.
Definitions
Smoking Beliefs
A smoker was divers as a patient who smoked at the time of surgery and/or smoked at ane year after surgery. A permanent smoker was divers as a patient who smoked at surgery, at 1 year after surgery, and at 5 years after surgery. A nonsmoker was a patient who never smoked or who smoked in the past merely did not fume at the time of surgery or subsequently. We defined a quitter since surgery equally beingness a patient who stopped smoking since surgery and who did not smoke at either ane twelvemonth or v years later on surgery. A recidivist smoker was a patient who stopped smoking but resumed smoking within five years after surgery.
Angina Pectoris
The severity of angina pectoris was scored according to the guidelines of the Canadian Cardiovascular Guild,19 and left ventricular function was graded according to the Coronary Artery Surgery Study (CASS) registry.20
Myocardial Infarction
A myocardial infarction was diagnosed past the presence of (1) large Q waves associated with changes in ST segments and T waves in specific and appropriate leads that indicate the location of the infarct or (2) specific enzyme alterations in combination with localized serial T moving ridge changes.
End Points
Death, myocardial infarction, coronary bypass surgery, coronary angioplasty, and recurrence of angina pectoris were considered clinical stop points.
End points were scored in a hierarchical style. Angina pectoris was scored as an end point only if until that moment, no other end indicate had been reached. Myocardial infarction was scored merely if a patient had not already undergone a reintervention procedure, and coronary bypass surgery and coronary angioplasty were scored but when they were the first postoperative reintervention procedure performed. In all other situations, these events were considered censored. This was done to avoid the confounding effect of i event causing another, for example, a coronary angioplasty procedure causing a myocardial infarction.
Comparisons
Event rates were analyzed multivariately at 3 unlike time intervals for the indicated groups: (i) from surgery to 15 years after surgery—smokers compared with nonsmokers; (2) from i to 15 years after surgery—smokers compared with quitters since surgery; (3) from five to fifteen years after surgery—permanent smokers and recidivist smokers compared with quitters since surgery; permanent smokers, recidivist smokers, and quitters since surgery compared with nonsmokers.
When groups were compared from i to 15 years and from 5 to 15 years, events that occurred before 1 or 5 years, respectively, were censored.
Statistical Assay
To identify prognostic covariates that might have "explained" a difference in survival time between smokers and nonsmokers, we estimated survival curves by the method described by Kaplan and Meier21 from the following variables: historic period, sex, obesity (body mass alphabetize), diabetes mellitus, elevated levels of serum cholesterol and triglycerides, hypertension, history of heart failure, preoperative angina pectoris, family history of coronary artery disease, number of vessels diseased, completeness of revascularization, number of distal anastomoses, left ventricular function, history of myocardial infarction, operation indication, the presence of collateral arteries, left master coronary avenue disease, and proximal left inductive descending artery disease. Differences in survival times between groups were calculated using the log-rank and Wilcoxon tests. All variables with a significance level of P<.10 in at least one of these univariate tests were introduced into a multivariate model as proposed past Cox.22 Age and sexual practice were e'er included. Finally, smoking beliefs was added to the model. We checked the assumption of proportional hazards for each predictor variable past estimating the plots of the logarithm of the cumulative run a risk. By using this analysis, we could predict the contained influence of smoking on different cardiac events in this population. The risk of having a cardiac consequence for a smoker in relation to a nonsmoker is reflected by the hazard ratio.
Results
Follow-up was complete in 99.eight% of the patients and averaged 15.4 years for the survivors. Thirteen patients (3%) died within thirty days after surgery. These patients were not included for analysis. Long-term results for this study group have been described elsewhere.23 The distribution of smokers, nonsmokers, quitters since surgery, permanent smokers, and recidivist smokers at the fourth dimension of surgery and at 1 and v years after surgery is presented in Table 2.
Death
Of the 169 smokers at the time of surgery, 66 (39%) died within fifteen years; 23% of these deaths were due to cardiac causes. Death occurred in 91 (37%) of the 244 patients who were nonsmokers at the fourth dimension of surgery; over half of these deaths (56 deaths; 62%) were due to cardiac causes.. From surgery to fifteen years afterward, multivariate Cox survival analysis revealed no significantly increased bloodshed for smokers compared with nonsmokers (Table 3), and assay from 1 to v years after surgery did not reveal significant differences in mortality between smokers, quitters since surgery, and nonsmokers (Tabular array four). Although assay from 5 to fifteen years subsequently surgery yielded an elevated mortality take chances of 1.7 times for permanent smokers compared with quitters since surgery, mortality risk was not significantly increased (Table 5). Also, mortality rates between recidivist smokers, quitters since surgery, and permanent smokers compared with nonsmokers from 5 to 15 years afterward surgery did not differ significantly (Tabular array half dozen). Expiry due to cardiac causes was also comparable between groups at all iii time intervals.
Myocardial Infarction
From surgery to 15 years afterward, no significant differences in myocardial infarction rate were found between smokers and nonsmokers (Table iii; the Figure). However, from ane to xv years afterward surgery, the myocardial infarction rate for smokers was 29% compared with 17% for patients who stopped smoking since surgery. Multivariate analysis revealed that at 1 year after surgery, smokers had an elevated risk for myocardial infarction that was 2.3 times the chance for quitters since surgery (P=.04) in the subsequent follow-up period (Table four). From v to 15 years after surgery, permanent smokers had a 2.5 times increased take a chance for myocardial infarction compared with quitters since surgery (P=.04, Table 6) and a 2.4 times increased chance compared with nonsmokers (P=.008, Table 6). The risk for myocardial infarction for recidivist smokers from 5 to 15 years afterward surgery was not significantly increased (1.9 and 1.8 times) compared with quitters since surgery and nonsmokers, respectively. Myocardial infarction rate from 5 to 15 years after surgery was comparable for quitters since surgery and nonsmokers (Table 6).
Coronary Bypass Surgery
From baseline coronary featherbed surgery to 15 years afterward, 28 of the 164 patients who smoked at the time of surgery underwent reoperation compared with 42 of the 244 baseline nonsmokers (P=NS, Tabular array 3). Perioperative bloodshed of this reoperation procedure was 7.1% in both groups. About patients were reoperated on considering of recurrence of angina pectoris. Emergency bypass surgery because of an unsuccessful coronary angioplasty was censored in our analysis. In the baseline smokers group, 3 patients (vii%) had a recent myocardial infarction before surgery, compared with 2 baseline nonsmokers (7%). Patients who smoked at 1 year afterward surgery had a 2.5 times elevated adventure of undergoing a reoperation compared with patients who quit smoking since surgery (P=.03, Table 4). Moreover, the risk for reoperation for patients who were still smoking at 5 years after surgery (permanent smokers) was three.three times (P=.03) the chance for quitters since surgery. Also, patients who started to smoke again within 5 years (recidivist smokers) had an elevated risk for reoperation of 3.4 times (P=.04) the adventure for quitters since surgery (Tabular array 6). Compared with nonsmokers, risks for permanent smokers and recidivist smokers were significantly increased, whereas quitters since surgery had outcomes comparable to nonsmokers (Tabular array 6).
Coronary Angioplasty
Fifty-seven patients underwent a coronary angioplasty as a commencement reintervention procedure after their coronary bypass surgery. Total periprocedural mortality was 2% and did not differ between smokers and nonsmokers. Most patients underwent coronary angioplasty because of recurrence of angina pectoris. A recent myocardial infarction (<i month before coronary angioplasty) was found in 12% of the patients. Comparisons between smokers, nonsmokers, quitters since surgery, permanent smokers, and recidivist smokers did not reveal significant differences in coronary angioplasty rate. Withal, there was a trend for an increased risk for the demand for coronary angioplasty for recidivist smokers and permanent smokers compared with nonsmokers, whereas event rates between quitters since surgery and nonsmokers were comparable (Table 6).
Angina Pectoris
Afterward fifteen years, merely 27% of the patients from the entire study population were notwithstanding gratis from angina pectoris. From surgery to 15 years later on and from 1 to xv years later surgery, effect rates for the return of angina pectoris between smokers, nonsmokers, and quitters since surgery were not significantly different. However, patients who were nevertheless smoking at 5 years after surgery or who started to fume within 5 years after surgery had a more than than twofold increased risk for the return of angina pectoris compared with patients who quit smoking since surgery (Tabular array 6). Again, the return of angina pectoris was comparable between quitters since surgery and nonsmokers (Table 6).
Discussion
Recently, at that place has been much controversy near whether smokers should receive the same opportunities for coronary bypass surgery as nonsmokers,17 18 and proposals have been fabricated to hold smokers answerable for heart disease costs.24 Discussion about this subject was based mainly on the consequent finding that continued smoking after coronary bypass surgery increases mortality and myocardial infarction rate. However, to the best of our cognition, no information are available on the risks for death and myocardial infarction after coronary bypass for patients who continued to smoke or who started to smoke again afterwards surgery compared with patients who stopped smoking since surgery. Moreover, questions most the gamble for reoperation and coronary angioplasty subsequently coronary featherbed surgery for smokers besides have remained unanswered.
The results of this report showed that patients who connected to smoke or patients who started to smoke once again after coronary bypass surgery had increased risks not only for myocardial infarction merely also for coronary featherbed surgery and recurrence of angina pectoris compared with patients who stopped smoking since surgery and patients who did not smoke. Moreover, clinical outcome later on surgery for patients who stopped smoking since surgery was like to nonsmokers.
In dissimilarity with other studies, we did non observe a strong relation between smoking behavior and survival. A possible explanation could be not only that the deleterious furnishings of smoking may be mediated by the chronic process of atherosclerotic progression in the grafts and the native system but also that smoking is positively correlated with immediate perioperative morbidity and mortality, mainly due to pulmonary infections.25 Because we aimed to describe the long-term effects of smoking and smoking cessation, nosotros did non include patients who died inside 30 days after surgery, which could have biased the results.
The association betwixt smoking behavior and myocardial infarction is already recognized. Hartz et al8 found a meaning clan betwixt smoking and myocardial infarction for men >50 years erstwhile. In a study from Rosenberg et al,7 smoking was found to increase the hazard for a 2nd myocardial infarction in women, and the risk increased with the number of cigarettes smoked. In some other study in men <55 years erstwhile, Rosenberg et alfifteen showed that the estimated relative risk for myocardial infarction for smokers compared with those who never smoked was 2.9. Hermanson et al13 concluded that, in older and in younger patients, patients with coronary avenue disease who continued to smoke had a relative hazard of 1.five for myocardial infarction compared with quitters. Wilhelmsson et alhalf-dozen plant that patients who stopped smoking after their first myocardial infarction had but one-half the rate of nonfatal recurrences every bit those who continued to fume. Åberg et al16 also found a lower frequency of reinfarction in a 10-twelvemonth follow-up study. Thus, although in that location is a large trunk of testify that smoking is related to myocardial infarction and that smoking abeyance lessens the chance of this event, in that location are few multivariately analyzed information about its furnishings after coronary featherbed surgery.
Our findings that smoking has an increased run a risk for the render of angina pectoris back up the results from the CASS study,xiv in which it was found that smokers, in comparison with nonsmokers, were less likely to remain free from angina pectoris afterwards 10 years in both the patient groups randomized to medical handling and the coronary bypass surgery group. There are few other studies that examine the influence of smoking subsequently coronary bypass surgery on angina pectoris. Moreover, hardly any data are available about the effects of smoking behavior on the need for reintervention, either operative or by angioplasty.
Nosotros report on the effects of smoking behavior on clinical events after venous coronary bypass surgery. At present, it has been shown that arterial grafts might take an improved outcome over venous grafts.26 27 Nevertheless, for a variety of reasons, venous grafts continue to be used in the majority of coronary featherbed surgery patients, mostly in combination with arterial grafts.28 29 thirty Since it is conceivable that venous conduits will be the first to cause clinical events, factors that influence the clinical outcome of patients with venous grafts remain important.
The present study has some shortcomings. First, we did not assess the total life consumption of cigarettes, and although we recorded number of cigarettes smoked, groups became too small to find any meaning differences. 2nd, in that location may have been other factors intercorrelating with smoking behavior that nosotros did not record. For example, social status was not recorded, although differences in social status in the Netherlands are very small-scale. Finally, smoking status was assessed by asking patients well-nigh their smoking behavior. Nosotros were not able to cheque the expressed smoking behavior by biochemical validation, and this remains a possible source of bias.
Despite these imperfections, on the basis of our prospective, multivariate analysis, at that place is a strong indication that patients who continue to smoke or who outset smoking once again later on coronary bypass surgery accept an elevated adventure non only for myocardial infarction but also for the return of angina pectoris and the need for coronary bypass surgery. Therefore, we conclude that smoking cessation subsequently coronary featherbed surgery may have important beneficial effects on long-term cardiac morbidity.
- Download figure
- Download PowerPoint
Effigy one. Kaplan-Meier survival curves representing freedom from clinical events for quitters since surgery, recidivist smokers, and permanent smokers, from 5 to 15 years afterward coronary bypass surgery.
| Smokers (n=169) | Nonsmokers (n=244) | P | |
|---|---|---|---|
| Hateful age, y (range) | 51.9 (thirty-69) | 52.ix (20-73) | NS |
| Sexual practice | |||
| Male | 95 | 86 | <.01 |
| Female | 5 | xiv | <.01 |
| Body mass alphabetize | |||
| <25 | 24 | 18 | NS |
| ≥25 | 72 | 79 | NS |
| Unknown | iv | iii | NS |
| Triglycerides | |||
| <2.0 mmol/Fifty | 51 | 61 | <.05 |
| ≥2.0 mmol/L | 26 | 24 | NS |
| Unknown | 23 | 15 | NS |
| Cholesterol | |||
| <6.5 mmol/L | xvi | nineteen | NS |
| ≥six.5 mmol/L | 63 | 68 | NS |
| Unknown | 21 | 13 | <.05 |
| Diabetes mellitus | |||
| Yes | two | 2 | NS |
| No | 81 | 74 | NS |
| Unknown | 17 | 24 | NS |
| Hypertension | |||
| Aye | 27 | 31 | NS |
| No | 73 | 69 | NS |
| Heart failure | |||
| Yes | 2 | one | NS |
| No | 98 | 99 | NS |
| AP I & Ii (CCS) | 41 | 38 | NS |
| AP III (CCS) | 31 | 42 | <.05 |
| AP IV (CCS) | 28 | 20 | NS |
| Family unit history | |||
| Positive | 10 | 6 | NS |
| Negative | 76 | 80 | NS |
| Unknown | xv | xiv | NS |
| 1-Vessel illness | 18 | xiv | NS |
| two-Vessel disease | 37 | 36 | NS |
| 3-Vessel affliction | 45 | 50 | NS |
| Revascularization | |||
| Complete | 69 | 62 | NS |
| Incomplete | 31 | 38 | NS |
| ≤3 Anastomoses | 62 | 62 | NS |
| >3 Anastomoses | 38 | 38 | NS |
| Left ventricular function | |||
| CASS 5-seven | 61 | 67 | NS |
| CASS 8-10 | xx | 19 | NS |
| CASS >ten | nineteen | xiv | NS |
| History of MI | |||
| No | 53 | 48 | NS |
| Yep | 47 | 51 | NS |
| Unknown | one | i | NS |
| Stable AP | 66 | 77 | <.05 |
| Unstable AP | 34 | 23 | <.05 |
| Collaterals | 59 | sixty | NS |
| No collaterals | 41 | xl | NS |
| Left master CAD | sixteen | 9 | <.05 |
| Prox. LAD disease | 36 | 43 | NS |
| At Fourth dimension of Surgery | 1 Year Afterwards Surgery | 5 Years Afterwards Surgery | |
|---|---|---|---|
| Nonsmokers | 244 (59) | 223 (54) | 190 (45) |
| Smokers | 169 (41) | 95 (23) | … |
| Quitters since surgery | … | 72 (17) | l (12) |
| Permanent smokers | … | … | 68 (sixteen) |
| Recidivist smokers | … | … | 45 (11) |
| Unknown | 2 (0.5) | 20 (5) | 10 (ii) |
| Died after 30 days after surgery | … | 5 (one) | 24 (6) |
| Other | … | … | 28 (vii) |
| Total | 415 | 415 | 415 |
| Event | Smokers (n=169), % | Nonsmokers (n=244), % | Multivariate Take a chance Ratio | Multivariate Probability Value |
|---|---|---|---|---|
| Expiry | 39 | 36 | 1.2 (0.8-ane.six) | .36 |
| Myocardial infarction | 22 | 18 | 1.1 (0.vii-i.9) | .61 |
| Reoperation | 21 | 21 | 1.0 (0.6-i.6) | .95 |
| Coronary angioplasty | 21 | fifteen | 1.vii (ane.0-2.8) | .06 |
| Angina pectoris | 77 | 79 | one.ane (0.8-1.3) | .72 |
| Issue | Smokers (n=95), % | Quitters Since Surgery (north=72), % | Multivariate Run a risk Ratio | Multivariate Probability Value |
|---|---|---|---|---|
| Death | 39 | 36 | 0.nine (0.v-ane.6) | .73 |
| Myocardial infarction | 29 | 15 | two.3 (ane.ane-5.1) | .04 |
| Reoperation | 30 | 12 | ii.v (ane.1-5.9) | .03 |
| Coronary angioplasty | twenty | 24 | i.iii (0.vii-2.vii) | .44 |
| Angina pectoris | 84 | 72 | 1.two (0.8-1.7) | .forty |
| Event | Nonsmokers | Quitters Since Surgery | Permanent Smokers | Recidivist Smokers |
|---|---|---|---|---|
| Death | 36 | 28 | 44 | 30 |
| Myocardial infarction | 15 | 15 | 34 | 23 |
| Reoperation | 16 | nine | 31 | 28 |
| Coronary angioplasty | 15 | xvi | 20 | 28 |
| Angina pectoris | 70 | 56 | 83 | 78 |
| Event | Compared With Quitters Since Surgery | Compared With Nonsmokers | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Permanent Smokers (northward=68) | Recidivist Smokers (n=45) | Quitters Since Surgery (n=50) | Permanent Smokers (n=68) | Recidivist Smokers (n=45) | ||||||
| Adventure Ratio | P | Hazard Ratio | P | Take a chance Ratio | P | Adventure Ratio | P | Gamble Ratio | P | |
| Death | ane.7 (0.8-iii.5) | .fifteen | 1.0 (0.4-two.ii) | .96 | 0.8 (0.4-ane.v) | .50 | 1.iv (0.ix-ii.3) | .13 | 1.7 (0.eight-three.v) | .73 |
| MI | two.v (ane.0-half dozen.2) | .04 | 1.9 (0.7-5.2) | .twenty | 0.9 (0.four-ii.two) | .88 | 2.4 (1.3-4.4) | .008 | one.eight (0.eight-3.9) | .14 |
| Reoperation | 3.3 (1.i-9.9) | .03 | 3.4 (1.ane-xi) | .04 | 0.seven (0.2-1.ix) | .42 | 2.three (1.3-4.3) | .008 | 2.3 (i.ane-iv.eight) | .03 |
| PTCA | 1.ix (0.7-v.0) | .21 | 1.eight (0.7-5.1) | .24 | 1.0 (0.4-two.3) | .94 | 1.9 (0.9-3.9) | .09 | 2.0 (1.0-4.2) | .07 |
| AP | 2.0 (1.1-three.6) | .02 | ii.1 (one.2-3.7) | .01 | 0.eight (0.5-1.two) | .26 | i.5 (1.0-2.2) | .06 | 1.5 (0.9-two.2) | .09 |
Footnotes
References
- 1 Weintraub WS, Klein LW, Seelaus PA, Agarwal JB, Helfant RH. Importance of total life consumption of cigarettes equally a risk factor for coronary avenue illness. Am J Cardiol. . 1985; 55:669-672. CrossrefMedlineGoogle Scholar
- ii Fitzgibbon GM, Leach AJ, Kafka HP. Atherosclerosis of coronary artery bypass grafts and smoking. Can Med Assoc J . 1987; 136:45-47. MedlineGoogle Scholar
- 3 Solymoss BC, Nadeau P, Milette D, Campeau Fifty. Late thrombosis of saphenous vein coronary featherbed grafts related to gamble factors. Apportionment. 1988;78(suppl I):I-140-I-143. Google Scholar
- four Ramanathan KB, vander Zwaag R, Maddock V, Kroetz FW, Sullivan JM, Mirvis DM. Interactive effects of historic period and other adventure factors on long-term survival after coronary artery surgery. J Am Coll Cardiol . 1990; 15:1493-1499. CrossrefMedlineGoogle Scholar
- 5 Mulcahy R, Hickey N, Graham IM, MacAirt J. Factors affecting the 5 twelvemonth survival rate of men post-obit acute coronary heart illness. Am Heart J . 1977; 93:556-559. CrossrefMedlineGoogle Scholar
- 6 Wilhelmsson C, Vedin JA, Elmfeldt D, Tibblin 1000, Wilhelmsen L. Smoking and myocardial infarction. Lancet . 1975; 1:415-420. CrossrefMedlineGoogle Scholar
- 7 Rosenberg L, Kaufman DW, Helmrich SP, Miller DR, Stolley PD, Shapiro S. Myocardial infarction and cigarette smoking in women younger than 50 years of age. JAMA . 1985; 253:2965-2969. CrossrefMedlineGoogle Scholar
- 8 Hartz AJ, Barboriak PN, Anderson AJ, Hoffmann RG, Barboriak JJ. Smoking, coronary artery apoplexy, and nonfatal myocardial infarction. JAMA . 1981; 246:851-853. CrossrefMedlineGoogle Scholar
- 9 Jenkins CD, Zyzanski SJ, Rosemam RH. Gamble of new myocardial infarction in middle-aged men with manifest coronary eye illness. Circulation . 1976; 53:342-347. CrossrefMedlineGoogle Scholar
- ten Mulcahy R. Influence of cigarette smoking on morbidity and mortality later myocardial infarction. Br Middle J . 1983; 49:410-415. CrossrefMedlineGoogle Scholar
- 11 Hallstrom AP, Cobb LA, Ray R. Smoking as a gamble factor for recurrence of sudden cardiac arrest. N Engl J Med . 1986; 314:271-275. CrossrefMedlineGoogle Scholar
- 12 Vlietstra RE, Kronmal RA, Oberman A, Frye RL, Kilip T. Effect of cigarette smoking on survival of patients with angiographically documented coronary artery disease. JAMA . 1986; 255:1023-1027. CrossrefMedlineGoogle Scholar
- 13 Hermanson B, Omenn GS, Kronmal RA, Gersh BJ, for Participants in the Coronary Artery Surgery Study. Beneficial six-year outcome of smoking cessation in older men and women with coronary artery affliction. Northward Engl J Med . 1988; 319:1365-1369. CrossrefMedlineGoogle Scholar
- xiv Cavender JB, Rogers WJ, Fisher LD, Gersh BJ, Coggin CJ, Meyers WO, for the CASS Investigators. Effects of smoking on survival and morbidity in patients randomized to medical or surgical therapy in the Coronary Artery Surgery Study (CASS): ten-year follow-up. J Am Coll Cardiol . 1992; 20:287-294. CrossrefMedlineGoogle Scholar
- fifteen Rosenberg Fifty, Kaufman DW, Helmrich SP, Shapiro S. The risk of myocardial infarction later on quitting smoking in men under 55 years of age. Northward Engl J Med . 1985; 313:1511-1514. CrossrefMedlineGoogle Scholar
- 16 Åberg A, Bergstrand R, Johansson Southward, Ulvenstam G, Vedin A, Wedel H, Wilhelmsson C, Wilhelmsen L. Cessation of smoking after myocardial infarction: effects on mortality subsequently 10 years. Br Heart J . 1983; 49:416-422. CrossrefMedlineGoogle Scholar
- 17 Underwood MJ, Bailey JS. Should smokers be offered coronary bypass surgery? BMJ . 1993; 306:1047-1050. CrossrefMedlineGoogle Scholar
- 18 Powell JT, Greenhalgh RM. Arterial bypass and smokers. BMJ . 1994; 308:607-608. CrossrefMedlineGoogle Scholar
- 19 Campeau L. Grading of angina pectoris. Circulation . 1976; 54:522-523. MedlineGoogle Scholar
- 20 CASS Principal Investigators and Their Associates. National Heart, Lung, and Claret Found Coronary Artery Surgery Study: a multicenter comparison of the effects of randomized medical and surgical treatment of mildly symptomatic patients with coronary artery disease, and a registry of consecutive patients undergoing coronary angiography. Circulation. 1981;63(suppl I):I-1-I-81. Google Scholar
- 21 Kaplan E, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc . 1958; 53:457-481. CrossrefGoogle Scholar
- 22 Cox DR. Regression models and life tables. J R Stat Soc . 1972; 34:187-202. Google Scholar
- 23 van Brussel BL, Plokker HWM, Ernst SMPG, Ernst NM, Knaepen PJJ, Kommen EM, Tijssen JGP, Vermeulen FEE, Voors AA. Venous coronary avenue bypass surgery: a 15-year follow-up written report. Circulation . 1993; 88:87-92. Google Scholar
- 24 Kaesemeyer WH. Belongings smokers accountable for center affliction costs. Circulation . 1994; 90:1029-1032. CrossrefMedlineGoogle Scholar
- 25 Warner MA, Offord KP, Warner ME, Lennon RL, Conover MA, Jansson-Schumacher U. Part of preoperative abeyance of smoking and other factors in postoperative pulmonary complications: a blinded prospective study of coronary artery bypass patients. Mayo Clin Proc . 1989; 64:609-616. CrossrefMedlineGoogle Scholar
- 26 Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW, Golding LAR, Gill CG, Taylor PC, Sheldon WC, Proudfit WL. Influence of the internal mammary artery graft on 10 year survival and other cardiac events. N Engl J Med . 1986; 314:i-7. CrossrefMedlineGoogle Scholar
- 27 Sergeant P, Lesaffre East, Flameng Westward, Suy R, Blackstone Eastward. The return of clinically axiomatic ischemia after coronary artery bypass grafting. Eur J Cardiothorac Surg . 1991; 5:447-457. CrossrefMedlineGoogle Scholar
- 28 van Sterkenburg SMM, Ernst JMPG, Brutel de la Rivière A, Defouw JAM, Hamerlynck RPHM, Knaepen PJ, van Swieten HA, Vermeulen FEE. Triple sequential grafts using the internal mammary artery: an angiographic and brusk-term follow-upwards written report. J Thorac Cardiovasc Surg . 1992; 104:threescore-65. MedlineGoogle Scholar
- 29 Grondin CM, Campeau 50, Thornton JC, Engle JC, Cross FS, Schreiber H. Coronary avenue bypass grafting with saphenous vein. Apportionment. 1989;79(suppl I):I-24-I-29. Google Scholar
- 30 Bourassa MG. Fate of venous grafts: the past, the nowadays, and the time to come. J Am Coll Cardiol . 1991; 17:1081-1083.CrossrefMedlineGoogle Scholar
Source: https://www.ahajournals.org/doi/10.1161/01.CIR.93.1.42
0 Response to "Can I Smoke Again After Dr"
Post a Comment