Is cytisine contraindicated in smoking patients with coronary artery disease after percutaneous coronary intervention?

Abstract

Background: Cytisine is contraindicated, and its effects have not been evaluated in patients with coronary artery disease (CAD).
Aims: The safety, feasibility, and short-term efficacy of cytisine for smoking cessation were evaluated in active smokers with CAD after percutaneous coronary interventions (PCI).
Methods: Patients with stable CAD and acute coronary syndromes (ACS), who smoked at least 10 cigarettes per day, were included 30 days post PCI and offered cytisine therapy. Adverse events, smoking activity, and drug adherence were assessed after 30 days.
Results: 117 patients participated (mean standard deviation [SD] age, 60.8 [7.7] years; men, 73.6%, median and interquartile range [IQR] of the number of pack-years, 40 [30–46.5]). Overall, 79 patients consented (study group) and 38 declined (control group) to use cytisine. At the follow-up visit, the incidence of adverse events did not differ between groups (17.7% vs 21%; P = 0.67). The groups had a similar success rate of smoking cessation in the intention-to-treat analysis (41.8% vs 36.8%; P = 0.61). In the as-treated analysis, patients who completed the therapy achieved a higher success rate than those who declined (69.7% vs 36.9%; P = 0.006) or did not complete therapy (69.7% vs 34.8%; P = 0.01). In the multivariable analysis, complete cytisine therapy and ACS at admission were associated with an increased and male sex with a decreased chance of smoking cessation.
Conclusions: Cytisine therapy is not associated with an increase in adverse events in patients with CAD after PCI. Cytisine is tolerable but effective in short-term follow-up only when the treatment is completed.