Bupropion for smoking cessation in patients hospitalized with acute myocardial
infarction: a randomized, placebo-controlled trial.
Author(s): Eisenberg MJ(1), Grandi SM, Gervais A, O'Loughlin J, Paradis G, Rinfret S,
Sarrafzadegan N, Sharma S, Lauzon C, Yadav R, Pilote L; ZESCA Investigators.
Affiliation(s): Author information:
(1)Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital/McGill
University, Montreal, Quebec City, Canada. mark.eisenberg@mcgill.ca
Publication date & source: 2013, J Am Coll Cardiol. , 61(5):524-32
OBJECTIVES: The purpose of this study was to examine smoking cessation rates
among smokers with AMI to determine whether bupropion, started in-hospital, is
safe and can improve cessation rates at 1 year.
BACKGROUND: Bupropion doubles quit rates in otherwise healthy smokers and
patients with stable cardiovascular disease. Although 2 previous trials examined
the use of bupropion in patients hospitalized with acute cardiovascular disease,
these studies have been inconclusive with respect to its safety and efficacy in
patients with acute myocardial infarction (AMI).
METHODS: We conducted a multicenter, double-blind, placebo-controlled, randomized
trial in smokers hospitalized with AMI. Participants received bupropion or
placebo for 9 weeks and were followed for 12 months. Both groups received
low-intensity counseling. Point prevalence abstinence was assessed by 7-day
recall and biochemical validation of expired carbon monoxide.
RESULTS: A total of 392 patients were randomized (mean age 53.9 ± 10.3 years);
83.5% were male; 64.9% had ST-segment elevation myocardial infarction). Patients
smoked a mean of 23.2 ± 10.6 cigarettes/day for a mean of 32.9 ± 12.4 years. At
12 months, point prevalence abstinence rates were 37.2% in the bupropion group
and 32.0% in the placebo group (p = 0.33; % difference after adjusting for
between center differences 3.9%). Continuous abstinence rates were 26.8% and
22.2%, respectively (p = 0.34). Major adverse cardiac event rates were similar
(13.0% vs. 11.0%, respectively; p = 0.64).
CONCLUSIONS: Two-thirds of patients return to smoking by 12 months after AMI.
Bupropion is well tolerated and seems to be safe to use in the immediate post-AMI
period. However, bupropion is not effective for smoking cessation in patients
post-AMI.
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