Among ACS patients who smoked, 47% persisted at 12 months, with smoking within 7 days post-discharge (OR 13.84) and household smoking exposure (OR 12.79) predicting persistence.
Nearly half of smokers presenting with an ACS continue to smoke at one year, with early resumption of smoking and household exposure being strong independent predictors of persistent smoking.
Abstract Background Smoking is a major modifiable cardiovascular risk factor, and promoting smoking cessation is a priority following an acute coronary syndrome (ACS). Adopting a healthy lifestyle after an ACS remains a challenge for patients and healthcare professionals. The early identification of ACS patients less likely to quit smoking could facilitate targeted interventions. Methods Patients admitted for an ACS during the year 2023 and who were current smokers at the time of admission and alive 12 months later were retrospectively identified at a single center and eligible for inclusion. Patients who accepted to participate in this study underwent a brief phone questionnaire regarding smoking habits during the 12-month period following the ACS admission. The study population was characterized with respect to demographic and clinical characteristics, severity of ACS (Killip-Kimbal class; baseline NT-proBNP; peak high-sensitivity cardiac troponin T), length of hospital stay, revascularization during ACS hospitalization, and smoking behavior (Fagerström score, which assesses nicotine dependence; household smoking; smoking within 7 days after ACS discharge). The study endpoint was defined as persistent smoking habits at 12 months follow up. Predictors of the study endpoint were identified by logistic regression analysis using SPSS software. Results Of 652 patients admitted with an ACS, 187 were smokers and 169 of these remained alive 12 months later. 124 patients accepted participation in this study. At 12 months follow up, 58 patients (47%) were active smokers. Active smokers were older, more often were exposed to household smoking (76% for active smokers vs 35% for patients who stopped smoking) and continued to smoke up to 7 days after ACS discharge (55% for active smokers vs 3% for patients who stopped smoking), and had higher Fagerström scores (Figure 1). Independent predictors of persistent smoking habits at 12 months follow up were active smoking within 7 days after ACS discharge (odds ratio 13.84; 95% CI, 2.21-86.82; p=0.005) and exposure to household smoking (odds ratio 12.79; 95% CI, 2.00-81.83; p=0.007). Conclusion Approximately 50% of smokers who present with an ACS continue to smoke at one year after discharge. ACS patients who do not quit smoking immediately after presentation and those who are exposed to household smoking after discharge are much less likely to abandon smoking habits. These findings underscore the importance of early intervention, particularly for these subgroups of patients.Figure 1
Gomes et al. (2025) studied this question. Among ACS patients who smoked, 47% persisted at 12 months, with smoking within 7 days post-discharge (OR 13.84) and household smoking exposure (OR 12.79) predicting persistence.