"A 30-Day Smoke-Free Window Prior to Carotid Endarterectomy in Asymptom" by Hassan Chamseddine, Alexander Shepard et al.
 

A 30-Day Smoke-Free Window Prior to Carotid Endarterectomy in Asymptomatic Patients Reduces Stroke Risk to Never-Smoker Levels

Document Type

Conference Proceeding

Publication Date

9-1-2024

Publication Title

J Vasc Surg

Abstract

Objectives: There is limited evidence on the impact of smoking on the long-term outcomes of elective carotid endarterectomy (CEA) in asymptomatic patients. This study aims to assess the impact of smoking on the long-term outcomes of stroke, myocardial infarction (MI), and death in asymptomatic patients undergoing CEA. Methods: Patients undergoing elective CEA for asymptomatic carotid artery stenosis between 2013 and 2023 were identified in the Vascular Quality Initiative. Patients were categorized into three groups: current smokers, former smokers, or never smokers. Former smokers were defined as those who abstained from smoking for at least 30 days prior to the procedure. Kaplan-Meier and Cox regression analyses were used to evaluate the long-term outcomes of stroke, MI, death, and their combination defined as major adverse cardiac events (MACE). Results: A total of 77,664 patients were included, of which 24% (n = 18,874) were current smokers, 51% (n = 39,374) were former smokers, and 25% (n = 19,416) were never smokers. The three groups had similar rates of perioperative complications. At 18-month follow-up, former smokers exhibited stroke rates that are comparable to never smokers, but lower than that of current smokers (never smoker 0.8% vs former smoker 0.9% vs current smoker 1.5%; log-rank P = .002) (Fig). On multivariate Cox regression analysis, current smokers had a 47% higher risk of stroke compared with former smokers (hazard ratio [HR], 1.47; 95% confidence interval [CI], 1.15-1.89; P = .002), whereas no significant difference was observed between former and never smokers (HR, 1.06; 95% CI, 0.82-1.38; P = .646). Perioperative smoking was significantly associated with mortality, with current smokers having a 27% increase in the risk of death compared with former smokers (HR, 1.27; 95% CI, 1.19-1.36; P < .001) and a larger 52% increase in the risk of death compared with never smokers (HR, 1.52; 95% CI, 1.39-1.66; P < .001) (Table). Conclusion: Current smokers who undergo CEA for asymptomatic disease do not have increased perioperative complications, but active smoking at the time of CEA is associated with increased risk of long-term stroke and death compared with nonsmokers and former smokers. Postponing CEA for asymptomatic disease until patients have refrained from smoking for over 30 days may improve long-term stroke risks and outcomes in this population. [Formula presented] [Formula presented]

Volume

80

Issue

3

First Page

e49

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