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BMC Cardiovascular Disorders

, 8:23

First Online: 17 September 2008Received: 03 August 2007Accepted: 17 September 2008DOI: 10.1186-1471-2261-8-23

Cite this article as: Efstratiadis, S., Kennard, E.D., Kelsey, S.F. et al. BMC Cardiovasc Disord 2008 8: 23. doi:10.1186-1471-2261-8-23


BackgroundThe adverse effects of tobacco abuse on cardiovascular outcomes are well-known. However, the impact of passive smoke exposure on angina status and therapeutic response is less well-established. We examined the impact of second-hand smoke SHS exposure on symptomatic improvement in patients with chronic ischemic coronary disease undergoing enhanced external counterpulsation EECP.

MethodsThis observational study included 1,026 non-smokers 108 exposed and 918 not-exposed to SHS from the Second International EECP Patient Registry. We also assessed angina response in 363 current smokers. Patient demographics, symptomatic improvement and quality of life assessment were determined by self-report prior and after EECP treatment.

ResultsNon-smoking SHS subjects had a lower prevalence of prior revascularization 85% vs 90%, and had an increased prevalence of stroke 13% vs 7% and prior smoking 72% vs 61%; all p < 0.05 compared to non-smokers without SHS exposure. Despite comparable degrees of coronary disease, baseline angina class, medical regimens and side effects during EECP, fewer SHS non-smokers completed a full 35-hour treatment course 77% vs 85%, p = 0.020 compared to non-smokers without SHS. Compared to non-smokers without SHS, non-smoking SHS subjects had less angina relief after EECP angina class decreased ≥ 1 class: 68% vs 79%; p = 0.0082, both higher than that achieved in current smokers 66%. By multivariable logistic regression, SHS exposure was an independent predictor of failure to symptomatic improvement after EECP among non-smokers OR 1.81, 95% confidence intervals 1.16–2.83.

ConclusionNon-smokers with SHS exposure had an attenuated improvement in anginal symptoms compared to those without SHS following EECP.

AbbreviationsARICAtherosclerosis Risk in Communities

CABGCoronary artery bypass graft surgery

CCSCCanadian Cardiovascular Society Classification

COCarbon Monoxide

CVDCardiovascular disease

EECPEnhanced external counterpulsation

IEPR-IISecond International EECP Patient Registry

MACEMajor adverse cardiovascular events

NONitric oxide

SHSsecond-hand smoke

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2261-8-23 contains supplementary material, which is available to authorized users.

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Autor: Stilianos Efstratiadis - Elizabeth D Kennard - Sheryl F Kelsey - Andrew D Michaels - the International EECP Patient Registr


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