Impact of myocardial revascularization method on smoking cessation: coronary artery bypass grafting versus percutaneous coronary intervention

Abstract Introduction: Smoking is a serious public health issue, being a precursor of heart disease and a predictor of sudden death due to myocardial ischemia. Major events in the patient's health can lead to radical changes in habits and the choice for different myocardial revascularization methods might differently impact smoking cessation and relapse. Objective: To study the rate and perpetuation of smoking cessation after myocardial revascularization comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). Methods: Smokers submitted to myocardial revascularization were divided into CABG and PCI groups. The research was conducted through interviews at the Hospital Santa Lucinda outpatient clinic. Patients with smoking cessation longer than 90 days before hospital admission, combined procedures, hospital readmission before 360 days after discharge, cases of death at any time, and emergency procedures were excluded from the study. The start of the smoking cessation period was determined as just after hospital discharge, with a follow-up of 12 months. Results: The proportion of patients reporting smoking relapse was significantly lower in the CABG than in the PCI group at 30 (11.1% vs. 20.8%; P=0.039) and at 180 days (23.1% vs. 41.5%; P=0.002), but no differences were observed between the two groups at 360 days after hospital discharge (51.9% vs. 54.1%; P=0.719). High levels of nicotine dependence and passive smoking showed to be important predictors of smoking relapse in the long-term. Conclusion: The occurrence of a major surgical procedure seems to have beneficial psychological effects, representing an interesting setting for smoking cessation counseling to have higher chances of success.

Incidência de aterosclerose em artérias radiais de cadáveres / Incidence of atherosclerosis in radial arteries of cadavers

OBJETIVO: Determinar a incidência de lesões ateroscleróticas obstrutivas e também lesões ateroscleróticas microscópicas em cadáveres acima de 35 anos, pesquisando toda a extensão da artéria radial. MÉTODO: Foram dissecadas ambas as artérias radiais de 29 cadáveres, em toda sua extensão, como se fossem ser utilizadas para cirurgia de revascularização do miocárdio. Foi realizada uma angiografia com contraste nessas artérias, a fim de detectar lesões ateroscleróticas obstrutivas. Após isso, cada artéria teve três fragmentos preparados em parafina, para se detectar histologicamente lesões ateroscleróticas e pré-ateroscleróticas. Os resultados foram confrontados com os fatores de risco para aterosclerose encontrados nesses cadáveres. RESULTADOS: Não foram encontradas lesões obstrutivas à angiografia. Quatro cadáveres apresentaram lesões ateroscleróticas à microscopia. Dos fatores de risco estudados, a idade mostrou associação significante para o aparecimento de lesões ateroscleróticas microscópicas. As artérias mediram, em média, 19,22 cm, nos homens, 17,45 cm, nas mulheres. Seu diâmetro médio foi 1,87 mm, nos homens e 1,72 mm, nas mulheres. CONCLUSÃO: Não foram encontradas lesões obstrutivas nas artérias radiais dos cadáveres estudados. A idade é fator que aumenta a incidência de lesão ateromatosa microscópica.

OBJECTIVE: To verify the incidence of atherosclerotic obstructions and microscopic atherosclerotic lesions in radial arteries dissected from cadavers of over 34-years-olds. METHODS: Twenty-nine cadavers had both radial arteries dissected as if they were going to be utilized as a coronary artery bypass grafts. An angiogram was performed to determine atherosclerotic obstruction of the radial arteries Subsequently, three fragments of the artery (proximal, medial, distal) were prepared on microscopic slides using hematoxylin-eosin in order to identify microscopic atherosclerotic lesions. Results were compared with risk factor found in patient's records: age, gender, hypertension, diabetes, history of smoking, myocardial infarctation, stroke, peripheral vascular disease, obesity, family history. RESULTS: No obstructive lesions were found in the angiograms. Four cadavers presented with microscopic atherosclerotic and pre-atherosclerotic lesions. Among the risk factors considered, only age was correlated with microscopic lesions. The arteries measured, on average, 19.22 cm in males and 17.45 cm in females. Theirs diameters were 1.87 mm for men and 1.72 for women. CONCLUSIONS: No atherosclerotic obstructions were found in the radial arteries of those cadavers. Age is a risk factor for microscopic atherosclerotic lesions.