CIGARETTE-SMOKING IN BRITISH MEN AND SELECTION FOR CORONARY-ARTERY BYPASS-SURGERY

Objective-To examine the relation between smoking status, clinical nee d, and likelihood of coronary artery bypass grafting in middle aged me n. Design-A prospective study of cardiovascular disease in British men aged 40 to 59 years, screened in 1978-80 and followed until December 1991. Subjects and setting-7735 men drawn from one general practice in each of 24 British towns. Main outcome measure-Coronary artery bypass graft surgery. Results-Of the 3185 current smokers, 38 (1.03/1000/yea r) underwent coronary artery bypass surgery compared with 47 of 2715 ( 1.45/1000/year) ex-smokers, and 19 of 1817 (0.85/1000/year) never-smok ers. Ex-smokers had a lower incidence of major ischaemic heart disease during follow up than current smokers. After adjustment for incidence of ischaemic heart disease during follow up, the hazard ratio of coro nary artery bypass surgery for ex-smokers compared with smokers was 1. 52 (95% confidence interval 0.99 to 2.34). Ex-smokers were more Likely at screening to recall a doctor diagnosis of ischaemic heart disease than smokers (7.1% v 5.3%), but among those who recalled a doctor diag nosis, smokers were less Likely to undergo coronary artery bypass surg ery than ex-smokers (9.4% v 3.5%, P = 0.026). By 1992, men defined as smokers at screening were no less likely than ex-smokers to have been referred to a cardiologist (18.5% v 18.8%), nor to report having under gone coronary angiography less frequently than ex-smokers (12.7% v 11. 4%). Conclusion-Even allowing for the strong relation between coronary artery bypass surgery and smokers were coronary artery bypass surgery than ex-smokers. A complex interplay exists between the men's experie nce of heart disease, the decision to stop smoking, and the willingnes s of doctors to consider coronary artery bypass surgery.