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Nicotine Patch Therapy in Smoking Cessation Reduces the Extend of
Exercise-Induced Myocardial Ischemia
John J. Mahmarian, MD, FACC, Lemuel A. Moye, MD, PhD, George A. Nasser, MD,
FACC, Sherif F. Nagueh, MD, FACC, Marilyn F. Bloom, RN, Neal L. Benowitz, MD,
Mario S. Verani, MD, FACC, William G. Byrd, PharmD, Craig M. Pratt, MD, FACC
July, 1997
Objectives.
We sought to determine the effects of nicotine patch therapy, when used to
promote smoking cessation, on myocardial ischemia in patients with coronary
artery disease.
Background.
Nicotine patches substantially increase quit rates among cigarette smokers, but
their safety in patients with myocardial ischemia who are attempting to quit
smoking is unknown.
Methods.
This is a prospective study using exercise thallium-201 single-photon emission
computed tomography (SPECT) to assess serial changes in the serial changes in
the total and ischemic myocardial perfusion defect size at baseline while
patients were smoking and during treatment with 14- and 21-mg nicotine patches.
Entry criteria required that patients 1) smoked ≥1 pack of cigarettes per
day; 2) had known coronary artery disease; and 3) had myocardial ischemia
(i.e., ≥5% reversible perfusion defect) on SPECT. All patients performed
symptom-limited treadmill exercise, and the baseline SPECT study served as its
own control. We interpreted and computer quantified the SPECT images with no
knowledge of the testing sequence.
Results.
Thirty-six of the 40 enrolled patients had exercise SPECT at baseline and
during treatment with at least 14-mg nicotine patches. These patients had an
initial perfusion defect size of 17.5 ± 10.6% while smoking an average
of 31 ± 11 cigarettes per day for 40 ± 12 years. A significant
reduction in the total perfusion defect size (p< 0.001) was observed from
baseline (17.5 ± 10.6%) to treatment with 14-mg (12.6 ± 10.1%)
and 21-mg (11.8 ± 9.9%) nicotine patches. This reduction occurred
despite an increase in treadmill exercise duration (p < 0.05) and higher
serum nicotine levels (p < 0.001). There was a significant correlation
between the reduction in defect size and exhaled carbon monoxide levels (p <
0.001) because patients reduced their smoking by ~74% during the trial.
Conclusion.
Nicotine patches, when used to promote smoking cessation, significantly reduce
the extent of exercise-induced myocardial ischemia as assessed by exercise
thallium-201 SPECT.
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