• Sarah B Windle, Payam Dehghani, Nathalie Roy, Wayne Old, François R Grondin, Iqbal Bata, Ayman Iskander, Claude Lauzon, Nalin Srivastava, Adam Clarke, Daniel Cassavar, Danielle Dion, Herbert Haught, Shamir R Mehta, Jean-François Baril, Charles Lambert, Mina Madan, Beth L Abramson, Mark J Eisenberg, and EVITA Investigators.
• Jewish General Hospital, McGill University (Windle, Eisenberg), Montréal, Que.; Prairie Vascular Research Network (Dehghani), University of Saskatchewan, Regina, Sask.; Centre de santé et de services sociaux de Chicoutimi (Roy), Chicoutimi, Que.; Sentara Cardiovascular Research Institute (Old), Norfolk, Va.; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Grondin), Hôtel-Dieu de Lévis site, Lévis, Que.; Queen Elizabeth II Health Sciences Centre (Bata), Halifax, NS; SJH Cardiology Associates and St. Joseph's Hospital Health Centre (Iskander), Liverpool, NY; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Lauzon), Hôpital de Saint-Georges site, Thetford Mines, Que.; Spartanburg Regional Medical Center (Srivastava), Spartanburg, SC; Valley Regional Hospital (Clarke), Kentville, NS; Toledo Hospital (Cassavar), Toledo, Ohio; Centre de santé et de services sociaux de Beauce (Dion), Beauce, Que.; Heart Center Research (Haught), Huntsville, Ala.; McMaster University and Hamilton Health Sciences (Mehta), Hamilton, Ont.; Dr. Georges-L.-Dumont University Hospital Centre (Baril), Moncton, NB; Florida Hospital Pepin Heart Institute (Lambert), Tampa, Fla.; Sunnybrook Health Sciences Centre (Madan), University of Toronto, Toronto, Ont.; St. Michael's Hospital (Abramson), Toronto, Ont.
• CMAJ. 2018 Mar 26; 190 (12): E347-E354.

BackgroundPatients who continue to smoke after acute coronary syndrome are at increased risk of reinfarction and death. We previously found use of varenicline to increase abstinence 24 weeks after acute coronary syndrome; here we report results through 52 weeks.MethodsThe EVITA trial was a multicentre, double-blind, randomized, placebo-controlled trial of varenicline for smoking cessation in patients admitted to hospital with acute coronary syndrome. Participants were randomly assigned (1:1) to receive varenicline or placebo for 12 weeks, in conjunction with low-intensity counselling. Smoking abstinence was assessed via 7-day recall, with biochemical validation using exhaled carbon monoxide. Participants lost to follow-up or withdrawn were assumed to have returned to smoking.ResultsAmong the 302 participants, abstinence declined over the course of the trial, with 34.4% abstinent 52 weeks after acute coronary syndrome. Compared with placebo, point estimates suggest use of varenicline increased point-prevalence abstinence (39.9% v. 29.1%, difference 10.7%, 95% confidence interval [CI] 0.01% to 21.44%; number needed to treat 10), continuous abstinence (31.1% v. 21.2%, difference 9.9%, 95% CI -0.01% to 19.8%) and reduction in daily cigarette smoking by 50% or greater (57.8% v. 49.7%, difference 8.1%, 95% CI -3.1% to 19.4%). Varenicline and placebo groups had similar occurrence of serious adverse events (24.5% v. 21.9%, risk difference 2.7%, 95% CI -7.3% to 12.6%) and major adverse cardiovascular events (8.6% v. 9.3%, risk difference -0.7%, 95% CI -7.8% to 6.5%).InterpretationVarenicline was efficacious for smoking cessation in this high-risk patient population. However, 60% of patients who received treatment with varenicline still returned to smoking. Trial registration: ClinicalTrials.gov, no. NCT00794573.© 2018 Joule Inc. or its licensors.

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