Smoking prior to revascularization for intermittent claudication raises risk of complications
Smoking is associated with an elevated risk for early complications after elective open and endovascular revascularization for intermittent claudication (IC), according to new data published in JAMA Cardiology.
The authors examined data from 14,350 cases of open or endovascular revascularization for IC. More than half (54.5%) of those patients were smokers before undergoing the procedure. Data was extrapolated from the Veterans Affairs Surgical Quality Improvement Program study.
Ninety-eight percent of patients were men, and the mean patient age was 65.7 years old.
The study's primary outcome was any respiratory, thrombosis, kidney, cardiac, sepsis or neurological complication within 30 days of the procedure.
The authors found that 1,594 patients (11.1%) had complications, and 57 (0.4%) died by 30 days.
Overall, researchers noted that among 7,710 propensity score–matched cases, smokers had a greater risk of any 30-day postprocedural complication compared with nonsmokers. The absolute risk difference (ARD) was 3.68%.
The team observed that, compared with nonsmokers, complications of any kind were more likely among smokers after undergoing endovascular revascularization, hybrid revascularization, and open revascularization.
Smokers also faced a higher risk of experiencing a wound complication or graft failure following an open intervention.
“In this well-balanced propensity score–matched cohort, smoking was associated with a 48% relative increase in the risk of any 30-day postprocedural complication compared with nonsmokers,” wrote lead author Katherine M. Reitz, MD, MSc, of the University of Pittsburgh School of Medicine, and colleagues. “Our findings support the strong societal guidelines emphasizing optimal medical therapy (OMT) and call for using comprehensive OMT programs that include smoking cessation therapies prior to revascularization for IC to reduce both early postprocedural complications and long-term cardiovascular disease morbidity and mortality.”
The full study is available here.