Smoking Status at Baseline and 10-Year Outcomes After Drug-Eluting Stent Implantation: Insights From the DECADE Cooperation

Background: Studies investigating 10-year outcomes according to smoking status at baseline in a largescale population undergoing percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation are scarce. Objectives: The authors sought to assess the association between smoking status at baseline and 10-year outcomes after PCI with DES implantation. Methods: We pooled individual participant data from 5 randomized trials including patients with 10-year follow-up after DES implantation. We divided participants into 2 groups as per smoking status at baseline. The main outcome was all-cause death. Secondary outcomes included cardiovascular death, myocardial infarction (MI), definite stent thrombosis (ST), and repeat revascularization (of target lesion, target vessel [TVR], or non-target vessel). Results: A total of 9,527 patients undergoing PCI with DES implantation were included in this analysis, (smoking n = 2,365; nonsmoking, n = 7,162). After multivariable adjustment, smoking was associated with a higher risk of all-cause death (HR_adj: 1.45; 95% CI: 1.33-1.59), cardiovascular death (HR_adj: 1.59; 95% CI: 1.41-1.80), and definite ST (HR_adj: 2.09; 95% CI: 1.34-3.26) over 10 years after PCI. The risk of MI was comparable in the first 30 days after PCI, but increased significantly from 1 to 10 years in the smoking group (HR_adj: 1.60; 95% CI: 1.36-1.90). Smoking was associated with a lower risk of target lesion revascularization and target vessel revascularization, but a comparable risk of non-target vessel revascularization. Conclusions: In patients undergoing PCI with DES, smoking at baseline is associated with an increased risk of death, MI, and ST, but a lower risk of repeat revascularization through to 10 years.