TY - JOUR
T1 - Effects of smoking in patients treated with cardiac resynchronization therapy
AU - Perrotta, Laura
AU - Xhaferi, Brunilda
AU - Chiostri, Marco
AU - Pieragnoli, Paolo
AU - Ricciardi, Giuseppe
AU - Di Biase, Luigi
AU - Natale, Andrea
AU - Ricceri, Ilaria
AU - Biria, Mazda
AU - Lakkireddy, Dhanunjay
AU - Valleggi, Alessandro
AU - Emdin, Michele
AU - Michelotti, Federica
AU - Mascioli, Giosuè
AU - Pandozi, Angela
AU - Santini, Massimo
AU - Padeletti, Luigi
N1 - Funding Information:
Conflict of interest Dr. Luigi Di Biase is a consultant for Hansen Medical and Biosense Webster. Dr. Natale received speaker honorariums from Boston Scientific, Biosense Webster, St. Jude Medical, Medtronic and Life Watch and research grant from St. Jude Medical. Dr. Santini receives grant support from Medtronic, St. Jude Medical, Biotronik and honoraria from Medtronic and Bayer and has a speakers’ bureau appointment with MSD, Medtronic, St. Jude, and AstraZeneca and an advisory board relationship with Boehringer-Ingelheim. Dr. Luigi Padeletti is consultant for Medtronic, St. Jude Medical, Biotronik and Boston Scientific. The other authors report no conflicts.
PY - 2014/4
Y1 - 2014/4
N2 - Smoking is associated with increased morbidity and mortality in cardiac patients. However, data on the prognostic impact of smoking in heart failure (HF) patients on cardiac resynchronization therapy with defibrillator (CRT-D) are absent. We investigated the effects of smoking on all-cause mortality and on a composite endpoint (all-cause death/appropriate device therapy), appropriate and inappropriate device therapy, in 649 patients with HF who underwent CRT-D between January 2003 and October 2011 in 6 Centers (4 in Italy and 2 in USA). 68 patients were current smokers, 396 previous-smokers (patients who had smoked in the past but who had quit before the CRT-D implant), and 185 had never smoked. The risk of each endpoint by smoking status was evaluated with both Kaplan-Meier and Cox proportional-hazard analysis. After adjusting for age, left ventricular ejection fraction, QRS width and ischemic etiology, both current and previous smoking were independent predictors of all-cause death [HR = 5.07 (95 % CI 2.68-9.58), p < 0.001 and HR = 2.43 (95 % CI 1.38-4.29), p = 0.002, respectively) and of composite endpoint [HR = 1.63 (1.04-2.56); p = 0.033 and HR = 1.46 (1.04-2.04) p = 0.027]. In addition, current smokers had a significantly higher rate of inappropriate device therapy compared to never smokers [HR = 21.74 (4.53-104.25), p = 0.005]. Our study indicates that in patients with HF who received a CRT-D device, current and previous smoking increase the event rate per person-time of death and of appropriate and inappropriate ICD therapy more than other known negative prognostic factors such as age, left ventricular dysfunction, prolonged QRS duration and ischemic etiology.
AB - Smoking is associated with increased morbidity and mortality in cardiac patients. However, data on the prognostic impact of smoking in heart failure (HF) patients on cardiac resynchronization therapy with defibrillator (CRT-D) are absent. We investigated the effects of smoking on all-cause mortality and on a composite endpoint (all-cause death/appropriate device therapy), appropriate and inappropriate device therapy, in 649 patients with HF who underwent CRT-D between January 2003 and October 2011 in 6 Centers (4 in Italy and 2 in USA). 68 patients were current smokers, 396 previous-smokers (patients who had smoked in the past but who had quit before the CRT-D implant), and 185 had never smoked. The risk of each endpoint by smoking status was evaluated with both Kaplan-Meier and Cox proportional-hazard analysis. After adjusting for age, left ventricular ejection fraction, QRS width and ischemic etiology, both current and previous smoking were independent predictors of all-cause death [HR = 5.07 (95 % CI 2.68-9.58), p < 0.001 and HR = 2.43 (95 % CI 1.38-4.29), p = 0.002, respectively) and of composite endpoint [HR = 1.63 (1.04-2.56); p = 0.033 and HR = 1.46 (1.04-2.04) p = 0.027]. In addition, current smokers had a significantly higher rate of inappropriate device therapy compared to never smokers [HR = 21.74 (4.53-104.25), p = 0.005]. Our study indicates that in patients with HF who received a CRT-D device, current and previous smoking increase the event rate per person-time of death and of appropriate and inappropriate ICD therapy more than other known negative prognostic factors such as age, left ventricular dysfunction, prolonged QRS duration and ischemic etiology.
KW - Cardiac outcomes
KW - Cardiac resynchronization therapy
KW - Heart failure
KW - Mortality
KW - Smoking
KW - Tachyarrhythmias
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U2 - 10.1007/s11739-012-0891-9
DO - 10.1007/s11739-012-0891-9
M3 - Article
C2 - 23250544
AN - SCOPUS:84897027150
SN - 1828-0447
VL - 9
SP - 311
EP - 318
JO - Internal and Emergency Medicine
JF - Internal and Emergency Medicine
IS - 3
ER -