CME: Smoking Cessation After PCI

CME: Smoking Cessation After PCI
Author Information (click to view)

Randal J. Thomas, MD, MS

Associate Professor of Medicine, Health Clinic
Division of Cardiovascular Diseases
Mayo Clinic

Randal J. Thomas, MD, MS, has indicated to Physician’s Weekly that he has no financial disclosures to report.

Figure 1 (click to view)
Figure 2 (click to view)
Target Audience (click to view)

This activity is designed to meet the needs of physicians.

Learning Objectives(click to view)

Upon completion of the educational activity, participants should be able to:


  1. Discuss the findings—and possible explanations for them—of a study that assessed trends and predictors of smoking cessation after percutaneous coronary intervention.

Method of Participation(click to view)

Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation.  A statement of credit will be available upon completion of an online evaluation/claimed credit form at  You must participate in the entire activity to receive credit.  If you have questions about this CME/CE activity, please contact AKH Inc. at

Credit Available(click to view)


CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s.  AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.


AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Commercial Support(click to view)

There is no commercial support for this activity.

Disclosures(click to view)

It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use & Investigational Product(click to view)

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer(click to view)

This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.

Faculty & Credentials(click to view)


Keith D’Oria – Editorial Director
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Randal J. Thomas, MD, MS
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

AKH planners and reviewers have no relevant financial relationships to disclose.


Randal J. Thomas, MD, MS (click to view)

Randal J. Thomas, MD, MS

Associate Professor of Medicine, Health Clinic
Division of Cardiovascular Diseases
Mayo Clinic

Randal J. Thomas, MD, MS, has indicated to Physician’s Weekly that he has no financial disclosures to report.

Despite the presence of smoke-free ordinances and emerging treatment strategies, smoking cessation rates do not appear to have improved after PCI over the past decade. Improvements in the delivery of systematic services that promote cessation, such as cardiac rehabilitation, should be emphasized in the future.

It has been well-documented in clinical studies that smoking cessation after patients undergo PCI can improve outcomes. Some research has identified certain predictors of smoking cessation after PCI, including beginning vaporizer, previous cigarette consumption and the number of coexisting coronary artery disease risk factors. Few studies, however, have assessed current trends in smoking cessation after PCI and looked at the potential impact of smoke-free policies that are being enacted throughout many parts of the United States. “Historically, patients who undergo PCI are a group that has more difficulty quitting smoking than others,” says Randal J. Thomas, MD, MS.

The Effect of Smoke-Free Policies

In a study published in the February 15, 2015 issue of the American Journal of Cardiology, Dr. Thomas and colleagues assessed trends and predictors of smoking cessation after PCI in Olmsted County, Minnesota. The investigators conducted the research at a time when local and statewide smoke-free public policies were enacted in Olmsted County. The study followed 2,306 patients who underwent their first PCI from 1999 to 2009 for 12 months. The researchers conducted structured telephone surveys at 6 and 12 months after PCI to assess smoking status and quit rates during the 10-year period.

The authors paid particular attention to quite rates around two dates when three smoke-free ordinances were implemented to reduce secondhand tobacco exposure in Olmsted County. The first date was January 1, 2002, when an ordinance was passed requiring restaurants to be smoke-free. The second was October 1, 2007, when ordinances required both workplaces and the entire state of Minnesota to be smoke-free. The data were then analyzed according to three time periods: 1991 to 2001, 2002 to 2006, and 2007 to 2009.

Troubling Trends

According to the results, there was a small but non-significant decrease in overall smoking rates among PCI recipients in Rochester, Olmstead County, and across the state of Minnesota. However, the percentage of current smokers among PCI patients was still higher than the percentage noted in the general population of these regional domains throughout the study period. Men were typically more likely to be smokers at the time of PCI than women (Figure 1), but this trend reversed in 2001 when 28% of women and 17% of men were smokers at the time of PCI.

The overall prevalence of smoking in patients who underwent PCI increased non-significantly from 20% in 1999 to 2001 to 24% in 2007 to 2009. When assessed at both 6 and 12 months, smoking cessation rates after PCI changed very little after analyzing data from 1999 to 2001 and 2007 to 2009 (Figure 2). “Our data are troubling because smoking cessation rates did not change significantly over the 10-year period,” says Dr. Thomas. “This occurred even though our analysis took into account time periods in which smoke-free policies were enacted.”

Examining Possible Reasons

Dr. Thomas says there are several possible explanations for the findings his study team observed. “Many smokers who undergo PCI are very unlikely to quit, even with the help of smoking cessation programs and the enactment of smoke-free ordinances,” he says. In addition, the study noted that smoking cessation therapies prescribed in the hospital setting after PCI may be underdosed or underused. Furthermore, follow-up after smoking cessation treatment may be lacking in outpatient settings.

Previous research that has examined the effect of community-wide smoke-free regulations and some studies suggest that these efforts help to reduce acute cardiac events. However, findings of the study by Dr. Thomas and colleagues suggest that similar improvements may not occur among PCI recipients. Overall, smoking rates have decreased among the general population over the past three decades, but this decrease does not appear to translate to improved smoking cessation rates in patients undergoing PCI.

Making Efforts

Importantly, the study identified several strong predictors of smoking cessation at 6 months after PCI. These included participation in cardiac rehabilitation, older age, and concurrent myocardial infarction at the time of PCI. “In our study, participating in cardiac rehabilitation was associated with significantly higher quit rates,” says Dr. Thomas. “This was probably due to a number of factors, including the benefits of individualized case management services that are provided through cardiac rehabilitation programs. This finding highlights the fact that these patients need more attentive care and monitoring. We need to improve the delivery of systematic services that promote smoking cessation. In the future, greater use of cardiac rehabilitation should be part of our efforts to improve smoking cessation rates after PCI.”


Readings & Resources (click to view)

Sochor O, Lennon RJ, Rodriguez-Escudero JP, et al. Trends and predictors of smoking cessation after percutaneous coronary intervention (from Olmsted County, Minnesota, 1999 to 2010). Am J Cardiol. 2015;115:405-410. Available at:

Hurt RD, Weston SA, Ebbert JO, et al. Myocardial infarction and sudden cardiac death in Olmsted County, Minnesota, before and after smoke-free workplace laws. Arch Intern Med. 2012;172:1635-1641.

Barth J, Critchley J, Bengel J. Psychosocial interventions for smoking cessation in patients with coronary heart disease. Cochrane Database Syst Rev. 2008;1:CD006886.

Barth J, Critchley J, Bengel J. Efficacy of psychosocial interventions for smoking cessation in patients with coronary heart disease: a systematic review and meta-analysis. Ann Behav Med. 2006;32:10-20.

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