Interpreting the benefits of preoperative varenicline in cardiac surgery

Abstract Yan et al. reported lower rates of myocardial infarction and major adverse cardiovascular events among cardiac surgery patients receiving preoperative varenicline compared with nicotine replacement therapy or continued smoking. This letter highlights several points that may help interpret these findings. A prescription within three months before surgery may not reflect the actual duration of preoperative abstinence, which is itself clinically relevant. Operative urgency and the time available for smoking cessation may also influence outcomes. In addition, the 2005–2025 study period spans major changes in perioperative practice. Future prospective studies should incorporate verified abstinence, treatment adherence, and surgical urgency.