PT  - JOURNAL ARTICLE
AU  - Windle, Sarah B.
AU  - Dehghani, Payam
AU  - Roy, Nathalie
AU  - Old, Wayne
AU  - Grondin, François R.
AU  - Bata, Iqbal
AU  - Iskander, Ayman
AU  - Lauzon, Claude
AU  - Srivastava, Nalin
AU  - Clarke, Adam
AU  - Cassavar, Daniel
AU  - Dion, Danielle
AU  - Haught, Herbert
AU  - Mehta, Shamir R.
AU  - Baril, Jean-François
AU  - Lambert, Charles
AU  - Madan, Mina
AU  - Abramson, Beth L.
AU  - Eisenberg, Mark J.
ED  - ,
TI  - Smoking abstinence 1 year after acute coronary syndrome: follow-up from a randomized controlled trial of varenicline in patients admitted to hospital
AID  - 10.1503/cmaj.170377
DP  - 2018 Mar 26
TA  - Canadian Medical Association Journal
PG  - E347--E354
VI  - 190
IP  - 12
4099  - http://www.cmaj.ca/content/190/12/E347.short
4100  - http://www.cmaj.ca/content/190/12/E347.full
SO  - CMAJ2018 Mar 26; 190
AB  - BACKGROUND: Patients 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.METHODS: The 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 Participants lost to follow-up or withdrawn were assumed to have returned to smoking.RESULTS: Among the 302 participants, abstinence declined over the course of the trial, with 34.4% abstinent 52 weeks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%).INTERPRETATION: Varenicline 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. NCT00794573See related article at www.cmaj.ca/lookup/doi/10.1503/cmaj.180125