• Won Young Jang, Su Nam Lee, Sung-Ho Her, Donggyu Moon, Keon-Woong Moon, Ki-Dong Yoo, Kyusup Lee, Ik Jun Choi, Jae Hwan Lee, Jang Hoon Lee, Sang Rok Lee, Seung-Wan Lee, Kyeong Ho Yun, and Hyun-Jong Lee.
• From the Department of Internal Medicine, Catholic University of Korea, Saint Vincent's Hospital, Suon, Gyeonggi-do, South Korea.
• Ann Saudi Med. 2021 Jul 1; 41 (4): 191-197.

BackgroundTobacco smoking and its harmful health effects also increase economic burdens globally. Surprisingly, despite the detrimental health consequences of smoking, some studies have shown better survival among smokers compared with non-smokers, a phenomenon called "smoker's paradox". However, the impact of smoking status on clinical outcomes in severe calcified coronary artery disease (CAD) patients has yet to be reported.ObjectivesInvestigate the impact of smoking on clinical outcomes in calcified CAD receiving rotational atherectomy (RA).DesignRetrospective review of medical records.SettingMulticenter registry in South Korea.Patients And MethodsThis multicenter registry included consecutive patients with calcified CAD who underwent RA at nine tertiary centers in Korea between January 2010 and October 2019.Main Outcome MeasuresTarget-vessel failure (TVF) which included the composite of cardiac death, target-vessel myocardial infarction (TVMI), and target-vessel revascularization (TVR).Sample Size583 lesions in 540 patients followed for a median of 16.1 months.ResultsLesions were divided into two groups: non-smokers (n=472, 81.0%) and smokers (n=111, 19.0%). TVF in the smoker group was significantly more frequent than in non-smoker group (log rank P=.016). The inverse probability of treatment weighting analysis also showed that smoking was significantly associated with a higher incidence of the primary outcome (HR: 1.617; 95% CI: 1.127-2.320; P=.009), cardiac death (HR 1.912; 95% CI: 1.105-3.311; P=.021), myocardial infarction (HR: 3.914; 95% CI: 1.884-8.132; P<.001), TVMI (HR: 3.234; 95% CI: 1.130-9.258; P=.029), and TVR (HR: 1.661; 95% CI: 1.043-2.643; P=.032). However, any bleeding was significantly observed less in the smokers.ConclusionSmoking is significantly associated with adverse clinical outcomes in CAD patients requiring RA.LimitationsRetrospective design.Conflicts Of InterestNone.

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