***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND The long-term clinical effects of smoking and smoking cessation after  venous coronary bypass surgery  have not been well established . METHODS AND RESULTS Four hundred fifteen patients who underwent venous coronary bypass surgery between April 1976 and April 1977 were followed up prospect ively for 15 years . Multivariate Cox survival analysis revealed that patients who smoked at the time of surgery had no elevated risks for clinical events compared with nonsmokers . However , smoking behavior at 1 and 5 years after surgery appeared to be an important predictor of clinical events during the subsequent follow-up period . Compared with patients who stopped smoking since surgery , smokers at 1 year after surgery had more than twice the risk for myocardial infa rct ion and reoperation . Patients who were still smoking at 5 years after surgery had even more elevated risks for myocardial infa rct ion and reoperation and a significantly increased risk for angina pectoris compared with patients who stopped smoking since surgery and patients who never smoked . Patients who started to smoke again within 5 years after surgery had increased risks for reoperation and angina pectoris . No differences in outcome were found between patients who stopped smoking since surgery and nonsmokers . CONCLUSIONS Our results show that smoking cessation after coronary bypass surgery may have important beneficial effects on clinical events during long-term follow-up There are some data showing lower mortality of smokers comparing to non-smokers in patients with ST-segment elevation myocardial infa rct ion ( STEMI ) when treated with thrombolysis or without reperfusion therapy . However , the role of smoking status is less established in patients with STEMI undergoing mechanical reperfusion . We evaluate the influence of smoking on outcome in patients with STEMI treated with primary percutaneous coronary intervention ( PCI ) .  A total of 1,086 patients enrolled into EUROTRANSFER Registry were included into present analysis . Patients were divided according to smoking status during STEMI presentation into those who were current smokers ( 391 patients , 36 % ) and non-smokers ( 695 patients , 64 % ) . Current smokers were younger and more often men and less frequently had high-risk features as previous myocardial infa rct ion , history of chronic renal failure , previous PCI , diabetes mellitus , anterior wall STEMI , and multivessel disease . Unadjusted mortality at 1 year was lower in current smokers comparing to non-smokers ( 3.3 vs. 9.5 % ; OR 0.33 CI 0.18–0.6 ; p = 0.0001 ) . However , after adjustment for age and gender by logistic regression , there was no longer significant difference between groups ( OR 0.7 ; CI 0.37–1.36 ; p = 0.30 ) . In conclusion , current smokers with STEMI treated with primary PCI have lower mortality at 1 year comparing to non-smokers , but this result may be explained by differences in baseline characteristics and not by smoking status itself . Current smokers developed STEMI more than 10 years earlier than non-smokers with similar age and sex-adjusted risk of death at 1 year . These results emphasize the role of efforts to encourage smoking cessation as prevention of myocardial infa rct ion We describe the 2- and 5-year prognoses following coronary artery bypass grafting ( CABG ) in relation to smoking habits among consecutive patients being operated on in western Sweden during a 3-year period . Among the 2,121 patients , 10.2 % admitted smoking at coronary angiography as compared with 7.5 % 2 years after CABG ( NS ) . Among smokers , the mortality during the subsequent 2 years was 8.9 % as compared with 6.5 % for exsmokers and 7.3 % for never smokers ( NS ) . During the 5-year follow-up , smokers had a mortality of 18.8 % as compared with 13.6 % for exsmokers and 12.5 % for never smokers ( p = 0.03 ) . When correcting for dissimilarities in previous history , smoking was a strongly significant independent ( p < 0.0001 ) predictor of 5-year mortality Background Cigarette smoking strongly increases morbidity and mortality from cardiovascular causes , but the relevance of smoking in patients treated with drug-eluting stents ( DES )  is unknown . Aims To assess the impact of smoking on the presentation and outcome of patients treated with DES .  Methods and results We analyzed data from the prospect i ve multicentre German Drug-Eluting Stent Registry ( DES.DE ) and identified 1,122 patients who had never smoked and 1,052 patients who were current smokers . Smokers were younger ( 56.5 vs. 69.4 years , p < 0.0001 ) , more often males , with less frequent diabetes and hypertension compared to non-smokers . Smokers presented more often with acute coronary syndromes . After a mean follow-up of 12.5 months , smokers had both higher mortality ( 4.6 vs. 2.7 % , p < 0.05 ) and myocardial infa rct ion ( MI ) rates ( 4.9 vs. 3 % , p < 0.01 ) . There was no significant difference between smokers and non-smokers in the rate of target vessel revascularization ( 9.8 vs. 11.4 % , p = 0.26 ) . Major adverse cardiac and cerebrovascular events ( defined as the composite of death , MI and stroke , MACCE ) were higher in smokers ( 10.6 vs. 6.1 % , p < 0.001 ) . Moreover , after adjustment for baseline clinical and angiographic variables , smoking continued to be a strong independent predictor for MACCE ( OR = 2.34 , 95 % CI 1.49–3.68 ) . In a subgroup analysis , we found that the increased risk of smoking was most prominent in patients presenting with stable angina pectoris ( OR = 3.71 , 95 % CI 1.24–2.57 , p < 0.05 ) . Smoking almost doubled the risk for MACCE in acute MI patients , though this did not reach statistical significance ( adjusted OR = 1.91 , 95 % CI 0.93–3.94 , p = 0.74 ) . Conclusion This large multicentre DES registry provides evidence that smokers treated with DES  , despite lower incidence of predisposing risk factors for atherosclerosis , experience higher rates of death and MI compared to non-smokers , particularly in the setting of stable coronary artery disease . Smoking has only marginal effects on target vessel revascularization rates in patients treated with DES AIMS The aim was to determine whether the effect of smoking on the development of peripheral or coronary artery disease might be mediated by other cardiovascular risk factors , including dietary antioxidant vitamin intake , serum low and high density lipoproteins , blood pressure , plasma fibrinogen , blood viscosity and markers of endothelial disturbance and fibrin turnover . METHODS AND RESULTS 1592 men and women aged 55 - 74 years were selected at r and om from 11 general practice s in Edinburgh , Scotl and and followed-up for 5 years . The incidences of peripheral arterial disease and coronary artery disease were 5.1 % and 11.1 % , respectively . Both conditions were more common in moderate and heavy smokers than in never smokers : cigarette smoking was a stronger risk factor for peripheral arterial disease than for coronary artery disease . Smoking was associated with reduced dietary antioxidant vitamin intake , serum high density lipoprotein cholesterol and diastolic blood pressure and with increased alcohol intake , serum triglycerides , blood viscosity , plasma fibrinogen , and markers of endothelial disturbance ( tissue plasminogen activator and von Willebr and factor antigens ) . Simultaneous adjustment for these risk factors reduced the relative risk of peripheral arterial disease only slightly , from 3.94 ( 95 % CI 2.04 , 7.62 ) to 2.72 ( 95 % CI 1.13 , 6.53 ) in heavy smokers and from 1.87 ( 95 % CI 0.91 , 3.85 ) to 1.70 ( 95 % CI 0.72 , 3.99 ) in moderate smokers . Similar adjustment also had little effect on the risk of coronary artery disease associated with smoking . CONCLUSION The combined effect of smoking on the cardiovascular risk factors studied may explain part of its influence on peripheral and coronary arterial disease , but the majority of the effect appears to be due to other mechanisms BACKGROUND Cigarette smoking is a well-known risk factor for development of coronary artery disease ( CAD ) . However , some studies have suggested a " smoker 's paradox , " meaning neutral or favorable outcomes in smokers who have developed CAD , especially myocardial infa rct ion ( MI ) . OBJECTIVES The study aim ed to examine the association of smoking status with clinical outcomes in the r and omized controlled SYNTAX ( SYNergy Between PCI With TAXUS and Cardiac Surgery ) trial at 5-year follow-up . METHODS Detailed smoking history was collected at baseline , 6-month , 1-year , 3-year , and 5-year follow-up . The composite endpoints included death/MI/stroke ( primary endpoint ) plus major adverse cardiac and cerebrovascular events ( MACCE ) ( combination of death/MI/stroke and target lesion revascularization ) according to patient smoking status . The comparison of 5-year clinical outcomes between the groups according to smoking status was performed with Cox regression using smoking status at baseline or smoking as a time-dependent covariate . RESULTS A sizeable proportion ( n = 322 , 17.9 % ) of patients had changing smoking status during 5-year follow-up . One in 5 patients with complex CAD was smoking at baseline . However , 60 % stopped after revascularization while others continued to smoke . Smokers had worse clinical outcomes due to a higher incidence of recurrent MI in both revascularization arms . Smoking was an independent predictor of the composite endpoint of death/MI/stroke ( hazard ratio [ HR ] : 1.8 ; 95 % confidence interval [ CI ] : 1.3 to 2.5 ; p = 0.001 ) and MACCE ( HR : 1.4 ; 95 % CI : 1.1 to 1.7 ; p = 0.02 ) . CONCLUSIONS Smoking is associated with poor clinical outcomes after revascularization in patients with complex CAD . This places further emphasis on efforts at smoking cessation to improve revascularization benefits . ( SYNTAX Study : TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries ; NCT00114972 ) BACKGROUND Several studies have demonstrated that the low-density lipoprotein cholesterol/high-denisty lipoprotein-cholesterol ( LDL-C/HDL-C ) ratio is an excellent predictor of cardiovascular disease . The aim of the present study was to determine whether the LDL-C/HDL-C ratio would affect outcome in patients after percutaneous coronary intervention ( PCI ) .  METHODS AND RESULTS Six-hundred-eighty-seven participants who underwent successful PCI for acute coronary syndromes or stable angina were enrolled . They were divided into 3 groups on the basis of the LDL-C/HDL-C ratio recorded 6 months after PCI : those with LDL-C/HDL-C≤1.5 ( n=125 ) ; 1.52 ( n=357 ) . In the 3 groups , the incidence of major adverse cardiac events ( MACE ) was measured during the 5 years after baseline evaluation . MACE was defined as cardiac death , non-fatal myocardial infa rct ion , new lesions , and restenosis . The median follow-up duration was 33 months . Kaplan-Meier analysis demonstrated that patients with LDL-C/HDL-C≤1.5 had a significantly lower incidence of MACE  after PCI than patients with 1.52.0 ( P<0.001 ) . In addition , Cox proportional hazards analysis indicated that the LDL-C/HDL-C ratio was correlated with the incidence of MACE ( HR=1.39 , 95 % confidence interval : 1.20 - 1.61 , P<0.001 ) . CONCLUSIONS The LDL-C/HDL-C ratio had an impact on long-term outcome in patients undergoing PCI Abstract Background : Despite increased risk for coronary artery disease and acute myocardial infa rct ion ( AMI ) , smokers have a paradoxically lower mortality after thrombolysis for AMI than non-smokers . We determined the clinical risk profiles and coronary flow characteristics of patients in the TIMI trials according to smoking status , focusing on microvascular flow . Methods : Among 2,573 patients in the TIMI 4 , 10A , 10B and TIMI 14 trials , epicardial flow  post-thrombolysis was measured using angiographic TIMI flow grade s and the corrected TIMI frame count ( CTFC ) . Microvascular flow was measured by TIMI Myocardial Perfusion Grade ( TMPG ) and , in TIMI 14 , the percentage of ST segment resolution . Results : Clinical ly , the mean age 
    Output:
    
Cigarette smoking has been shown to increase the likelihood of all-cause mortality in patients after coronary revascularization with PCI or CABG .
Smoking cessation is essential for  PCI or CABG patients to manage their coronary artery disease