The motivation to quit: smoking cessation rates in ACS versus elective PCI patients

Aims: Cigarette smoking remains a leading modifiable risk factor for both acute and chronic manifestations of coronary artery disease (CAD). While the association between smoking and cardiovascular morbidity is well-established, the clinical context in which patients are confronted with their diagnosis whether through an acute coronary syndrome (ACS) or an elective coronary angiography may influence their readiness and motivation to quit smoking. Exploring the interplay between clinical presentation and smoking cessation can provide valuable insights for targeted intervention strategies. This study aimed to compare six-month smoking cessation rates in active smokers undergoing stent implantation either following an ACS event or as part of an elective coronary angiography for stable CAD. Additionally, the research sought to identify clinical and psychological determinants associated with successful cessation in both groups. Methods: This retrospective observational study included 300 current smokers (150 in the ACS group and 150 in the elective PCI group), aged between 35 and 80 years. Demographic data, comorbidities (including diabetes mellitus, hypertension, cronic obstructive pulmonary disease(COPD), heart failure with preserved [HFpEF] and reduced ejection fraction [HFrEF]), and smoking status at six-month follow-up were collected. A psychological assessment using the Brief Illness Perception Questionnaire (BIPQ) was conducted in a entire cohort (n=300) to evaluate perceived severity and emotional impact. Statistical analyses included chi-square, t-tests, and multivariable logistic regression to determine independent predictors of cessation. Results: At six months, the smoking cessation rate was significantly higher among ACS patients (58%) compared to those undergoing elective PCI (32%) (p<0.001). Across the entire cohort, higher cessation rates were observed in individuals aged >50 years, female patients, those with diabetes, and especially among patients with HFrEF. BIPQ results across the full cohort showed significantly higher scores for perceived illness severity and emotional response among the ACS group. In multivariable analysis, ACS presentation (OR=2.3, p<0.001), HFrEF (OR=1.8, p=0.02), and female gender (OR=1.6, p=0.04) emerged as independent predictors of cessation. Conclusion: Smoking represents a universal and powerful risk factor across all spectra of coronary artery disease—both acute and stable. However, patients experiencing ACS may be more responsive to cessation efforts, possibly due to heightened emotional distress and perceived threat to life. Elective PCI patients, although equally at risk, may require different motivational strategies. These findings highlight the importance of integrating clinical context with psychological readiness when designing and delivering smoking cessation interventions in cardiology practice.(1,3)