Association of smoking with restenosis and major adverse cardiac events after coronary stenting: a meta-analysis

ABSTRACT

The association between smoking and clinical outcomes after coronary stenting is controversial. The aim of this meta-analysis was to assess the association between smoking and in stent restenosis [ISR], major adverse cardiac events [MACE], or major adverse cardiac and cerebrovascular events [MACCE] after coronary stenting. A search for studies published before December 2014 was conducted in PubMed, Embase, and Cochrane library. An inverse random weighted meta-analysis was conducted using logarithm of the odds ratio [OR] and its standard error for each study. Ten studies investigated the association between smoking and ISR. Overall, smoking was not associated with ISR [OR 1.05, 95% CI 0.79-1.41; I[2] = 47.8%]. Subgroup analysis also failed to show a significant association between smoking and ISR risk regardless of bare metal stent [BMS] and drug-eluting stent [DES] implantation. Eight studies explored the association between smoking and MACE, but no association was found [OR 0.92, 95% CI 0.77-1.10; I[2] = 25.5%], and subgroup analysis revealed that no distinct difference was found between BMS and DES implantation. Three studies investigated the association between smoking and MACCE and significant association was found [OR 2.09, 95% CI 1.43-3.06; I[2] = 21.6%].Our results suggest that in patients undergoing percutaneous coronary intervention with stent implantation, smoking is not associated with ISR and MACE; however, smoking is an independent risk factor for MACCE