Cor Vasa 2018, 60(4):e381-e386 | DOI: 10.1016/j.crvasa.2018.03.006

Impact of the radial versus femoral access for primary percutaneous intervention on smoking cessation rates: A paradoxus between the health related quality of life and smoking quitting?

Bulent Deveci^a, Ozcan Ozeke^b,*, Murat Gul^c, B. Acar^b, E. Hande Ozcan Cetin^b, Cengiz Burak^b, Serkan Cay^b, Serkan Topaloglu^b, Dursun Aras^b, Erdogan Ilkay^b

^a Canakkale Onsekiz Mart University, Department of Cardiology, Canakkale, Turecko

^b Health Sciences University, Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turecko

^c Aksaray University, Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Aksaray, Turecko

Background: Smoking cessation is potentially the most effective secondary prevention measure and improves prognosis after acute ST-segment elevation myocardial infarction (STEMI), but more than half of the patients continue to smoke after STEMI. The awareness of the disease's severity and the short hospital stay at the index STEMI have been found to be associated with persistent smoking after STEMI.

Objective: To assess whether the paradoxical relationship between smoking quitting rates and health-related quality of life (QOL) scores in STEMI patients undergoing primary percutaneous intervention (pPCI) by radial ( RA) versus femoral approach (FA).

Methods: Our population is represented by 138 STEMI patients undergoing pPCI by FA or RA. The smoking cessation rates and QOL scores were evaluated.

Results: Patients at RA group (46 patients,57 ± 9 years, 87% male) had a higher European Quality of Life-5 Dimensions (EQ-5D) index score at post-PCI first week compared to FA group (92 patients, 57±8 years, 75% male) (FA: median 0.81 [0.22] vs. RA: 1 [0.22], p = 0.042), although it was similar at baseline (FA: median 1 [0] vs. RA: 1 [0], p = 0.992). Total hospital length of stay (RA: median 3 [1] day vs. FA: 4 [1], p < 0.001) was significantly reduced in the RA group. Whereas the smoking cessation rates at one-year post-discharge were 41% in RA group, it was 67% in FA group (p = 0.003). Female sex, pain-to-door time and RA during p-PCI were independent predictors of continued smoking after STEMI.

Conclusion: This study shows that the smoking cessation was lower in RA group compared to FA group. The more comfortable conditions of STEMI management related to RA may cause a lower awareness of the disease severity and lower motivation to quit smoking. Therefore, it is important to inquire about smoking status at each clinical encounter, particularly in patients undergoing pPCI by the radial approach.

Keywords: Femoral approach; Primary percutaneous coronary intervention; Quitting; Radial approach; Smoking cessation; STEMI

Received: November 14, 2017; Revised: March 5, 2018; Accepted: March 7, 2018; Published: August 1, 2018  Show citation