Smoking history increases the risk of long-term mortality after thoracic endovascular aortic repair in patients with an uncomplicated type B dissection
Smoking is one of the most well-documented risk factors for cardiovascular disease—from heart attacks to aneurysms—but its impact on patients who undergo a common aortic surgery has been less clear. A 2020 study from Beijing Anzhen Hospital sheds light on this gap: for people with uncomplicated type B aortic dissection who receive thoracic endovascular aortic repair (TEVAR), a pre-operative smoking history nearly doubles their long-term mortality risk.
The Study: Who, What, and Why?
Led by Hui-Qiang Gao, Chang-Wei Ren, and colleagues from the Department of Cardiac Surgery and Department of Intervention at Beijing Anzhen Hospital (part of the Beijing Institute of Heart, Lung & Vascular Diseases, Capital Medical University), the research analyzed data from 751 patients treated for uncomplicated type B dissection between May 2001 and December 2013. The goal was to understand how smoking affects survival after TEVAR—a minimally invasive procedure that uses a stent to seal aortic tears and redirect blood flow.
First, some key definitions:
- Uncomplicated type B dissection: A tear in the descending aorta (the part of the main artery that runs down the spine) that does not cause immediate life-threatening issues like organ damage, uncontrollable high blood pressure, or a high risk of rupture.
- TEVAR: A surgery where doctors thread a stent through a blood vessel (usually in the leg) to the aortic tear. The stent seals the tear, allowing blood to flow normally through the “true” (healthy) part of the aorta and reducing pressure on the “false” (teared) lumen.
How the Study Worked
The 751 patients were split into two groups:
- Non-smokers: 414 patients with no history of sustained smoking (fewer than 100 total cigarettes in their lifetime).
- Smokers: 337 patients who had smoked at least 100 cigarettes before surgery.
All patients were followed for a median of 70 months (about 5.8 years), with check-ups every year to monitor aortic health. The team used statistical models to compare survival rates and adjust for other factors that could affect outcomes—like age, gender, body mass index (BMI), diabetes, alcohol use, and the number of stents used.
The Critical Results
The numbers tell a clear story about smoking’s long-term impact:
- Non-smokers: 97.6% survived 5 years after TEVAR; 87.0% survived 10 years.
- Smokers: 94.9% survived 5 years; just 73.8% survived 10 years.
After accounting for other variables (like age and diabetes), smokers had a 2.1-fold higher risk of death during follow-up compared to non-smokers. This means smokers were more than twice as likely to die over the long term—even after successful TEVAR.
Why Does Smoking Matter for TEVAR Outcomes?
While the study didn’t explore the exact biological mechanisms, researchers linked smoking to worse outcomes using established cardiovascular science:
- Residual dissection risk: Smoking may worsen “residual” tears in the aorta beyond where the stent is placed, increasing the chance of rupture over time.
- Atherosclerosis and stiffness: Smokers often have more plaque buildup (atherosclerosis) and calcium in the aortic wall, making the artery less flexible. This reduces the aorta’s ability to handle blood pressure changes, raising rupture risk.
- Other heart risks: Smoking is a top cause of coronary artery disease (narrowed heart arteries). Even after TEVAR, smokers face a higher risk of deadly conditions like heart attacks—adding to their long-term mortality risk.
Limitations to Consider
The study has important gaps:
- It didn’t measure how much patients smoked (e.g., packs per day) or if they quit after surgery.
- It didn’t track patients who started smoking after TEVAR.
Future research should explore these factors to better guide smoking cessation advice.
What This Means for Patients and Doctors
The takeaway is simple but powerful: quitting smoking before TEVAR can save lives. For patients with uncomplicated type B dissection, a smoking history is a strong predictor of worse long-term survival—even when the surgery itself is successful.
Doctors should emphasize smoking cessation as part of pre- and post-op care. For smokers who can’t quit on their own, structured programs (like counseling or medication) are critical to improving outcomes.
Study Source
This research was published in the Chinese Medical Journal in 2020 by Hui-Qiang Gao, Chang-Wei Ren, Sheng Yang, Lian-Jun Huang, Li-Zhong Sun, and Shang-Dong Xu from Beijing Anzhen Hospital, Capital Medical University.
doi.org/10.1097/CM9.0000000000000640
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