Three Life-Years Gained From Smoking Cessation After CABG surgery
Background: Previous studies have shown that smoking cessation after a cardiac event reduces the risk of subsequent mortality in patients, but the effect of smoking cessation in terms of prolonged life-years is not yet known.
Methods: We analyzed the 30-year clinical outcome of the first 1,041 consecutive patients (age at operation 51 years, 92% male) who successfully underwent isolated venous coronary artery bypass surgery between 1971 and 1980. All 551 smokers (53%) were included in this study. Of these, 43% stopped smoking throughout the first year whereas 57% persisted smoking.
Results: The median follow-up was 29 years (range 26-36 years). The cumulative 10-, 20-, and 30-year survival rates were 88%, 49%, and 19%, respectively, in the group of patients who quit smoking, and only 77%, 36%, and 11%, respectively, in the persistent smokers (P <.0001). After adjusting for all baseline characteristics, smoking cessation remained an independent predictor of lower mortality (hazard ratio 0.60, 95% CI 0.48-0.72). We were able to assess the exact life expectancy by calculating the area under the Kaplan-Meier curves. Life expectancy in the quitters was 20.0 years and 17.0 years in the persistent smokers (P <.0001).
Conclusions: Using 30-year follow-up data, we estimated that self-reported smoking cessation after coronary artery bypass surgery was associated with a life expectancy gain of 3 years. Smoking cessation turned out to have a greater effect on reducing the risk of mortality than the effect of any other intervention or treatment.

The causative relation between smoking and coronary heart disease (CHD) is well established with increased risks of mortality estimated between 50% and 300%. Previous studies have shown that smoking is strongly related to myocardial infarction (MI) and cardiac death in the general population. However, the predictive value of current smoking at the time of a cardiac event, such as survivors of coronary artery bypass graft (CABG), percutaneous transluminal coronary angioplasty, and nonfatal MI is less clear. Nevertheless, previous studies have shown that smoking cessation reduces the risk of subsequent mortality and further cardiac events after CABG, percutaneous transluminal coronary angioplasty, and MI, but the effect of smoking cessation in terms of prolonged life-years is not yet known. For this reason, we investigated this relation between smoking cessation and mortality after CABG. To this end, a group of 551 patients who smoked at the time of surgery was followed for 30 years. As that period comprises almost the whole further life cycle, we were able to calculate very precisely the exact life expectancy in quitters and persisted smokers.