Current Smoking, Smoking Cessation, and the Risk of Sudden Cardiac Death in Patients With Coronary Artery Disease

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Abstract
SUDDEN CARDIAC death (SCD) constitutes about one quarter of all coronary artery disease (CAD)–related major events and more than half of all CAD-related deaths. Ventricular arrhythmia is believed to be the most common direct cause.1,2 Nicotine produces a marked elevation in serum catecholamine concentration that is potentially arrhythmogenic.3 Smoking cessation is universally recommended in patients with CAD, and some of the adverse cardiovascular effects of cigarette smoking have been shown to dissipate with smoking cessation.4-8 However, in studies that have examined the risk factors for SCD separately in patients with and without preexisting CAD, the effect of continued cigarette smoking and smoking cessation has been well established only for subjects without known CAD. In contrast, once CAD becomes overt, the effect of smoking status on SCD risk is controversial.9-15