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Impact of smoking in patients undergoing transcatheter aortic valve replacement.

Background
The paradox that smokers have better clinical outcomes in cardiovascular diseases remains controversial. No literature exists studying impact of smoking on outcomes following transcatheter aortic valve replacement (TAVR).


Methods
We performed an electronic search of the 2011-2012 National Inpatient Sample (NIS) database to identify all TAVR hospitalizations. Outcomes were measured comparing smokers to non-smokers.


Results
A total of 8,345 TAVR hospitalizations were identified with 24% being smokers. Compared to non-smokers, smokers were younger (80.4±8.8 vs. 81.4±9.2 years, P<0.001), were more often men (63.6% vs. 47.8%, P<0.001), and had a higher disease burden. Despite a higher disease burden, smokers had lower post procedure stroke (2.8% vs. 3.1%), hemorrhage events (28.2% vs. 32.0%, P<0.05) and lower all cause in-hospital mortality (1.2% vs. 5.7%, adjusted odds ratio 0.21, 95% CI: 0.13-0.32, P<0.001) compared to non-smokers.


Conclusions
Despite having a higher cardiovascular disease burden, smokers had better outcomes compared to non-smokers. Therefore the smoker's paradox is applicable in the TAVR cohort.