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 nonsmokers. 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.