Smoking may be more harmful to vasospastic angina patients who take antiplatelet agents due to the interaction: Results of Korean prospective multi-center cohort

Seong Sik Cho, Sang Ho Jo, Hyun Jin Kim, Min Ho Lee, Won Woo Seo, Hack Lyoung Kim, Kwan Yong Lee, Tae Hyun Yang, Sung Ho Her, Seung Hwan Han, Byoung Kwon Lee, Keun Ho Park, Seung Woon Rha, Hyeon Cheol Gwon, Dong Ju Choi, Sang Hong Baek

Research output: Contribution to journalArticlepeer-review

Abstract

Background The interaction between smoking and the use of antiplatelet agents on the prognosis of vasospastic angina (VA) is rarely investigated. Methods VA-Korea is a nation-wide multi-center registry with prospective design (n = 1812). The primary endpoint was the composite occurrence of acute coronary syndrome (ACS), symptomatic arrhythmia, and cardiac death. Log-rank test and Cox proportional hazard model were for statistical analysis. Also, we conducted interaction analysis in both additive and multiplicative scales between smoking and antiplatelet agents among VA patients. For additive scale interaction, relative excess risk due to interaction (RERI) was calculated and for multiplicative scale interaction, the ratio of hazard ratio (HR) was calculated. All statistical analysis conducted by Stata Ver 16.1. Results Patients who were smoking and using antiplatelet agents had the highest incidence rate in the primary composite outcome. The incidence rate was 3.49 per 1,000 person-month (95% CI: 2.30-5.30, log-rank test for primary outcome p = 0.017) and HR of smoking and using antiplatelet agents was 1.66 (95%CI: 0.98-2.81). The adjusted RERI of smoking and using antiplatelet agents was 1.10 (p = 0.009), and the adjusted ratio of HR of smoking and using antiplatelet agents was 3.32 (p = 0.019). The current study observed the interaction between smoking and using antiplatelet agents in both additive and multiplicative scales. Conclusions Smoking was associated with higher rates of unfavorable clinical outcomes among VA patients taking antiplatelet agents. This suggested that VA patients, especially those using antiplatelet agents should quit smoking.

Original languageEnglish
Article numbere0248386
JournalPloS one
Volume16
Issue number4 April
DOIs
Publication statusPublished - 2021 Apr
Externally publishedYes

ASJC Scopus subject areas

  • General

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