Smokeless tobacco, snus, at admission for percutaneous coronary intervention and future risk for cardiac events

Ole Frobert, Christian Reitan, Dorothy K. Hatsukami, John Pernow, Elmir Omerovic, Pontus Andell

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Objective: To assess the risk of future death and cardiac events following percutaneous coronary intervention (PCI) in patients using smokeless tobacco, snus, compared with patients not using snus at admission for a first PCI.

Methods: The Swedish Coronary Angiography and Angioplasty Registry is a prospective registry on coronary diagnostic procedures and interventions. A total of 74 958 patients admitted for a first PCI were enrolled between 2009 and 2018, 6790 snus users and 68 168 not using snus. We used Cox proportional hazards regression for statistical modelling on imputed datasets as well as complete-case datasets.

Results: Patients using snus were younger (mean (SD) age 61.0 (±10.2) years) than patients not using snus (67.6 (±11.1), p<0.001) and more often male (95.4% vs 67.4%, p<0.001). After multivariable adjustment, snus use was not associated with the primary composite outcome of all-cause mortality, new coronary revascularisation or new hospitalisation for heart failure at 1 year (HR 0.98, 95% CI 0.91 to 1.05). In patients using snus at baseline who underwent a second PCI (n=1443), the duration from the index intervention was shorter for subjects who continued using snus (n=921, 63.8%) compared with subjects who had stopped (mean number of days 285 vs 406, p value=0.001).

Conclusions: Snus use at admission for a first PCI was not associated with a higher occurrence of all-cause mortality, new revascularisation or heart failure hospitalisation. Discontinuing snus after a first PCI was associated with a significantly longer duration to a subsequent PCI.

Original languageEnglish (US)
Article numbere001109
JournalOpen Heart
Issue number2
StatePublished - Oct 1 2019

Bibliographical note

Funding Information:
SCAAR, which is a part of the national Swedish Web System for Enhancement and Development of Evidence-based Care in Heart Disease Evaluated According to Recommended Therapies registry, holds data on all consecutive patients from all 30 centres that perform coronary angiography and PCI in Sweden. The registry is sponsored by the Swedish Health Authorities and is independent of commercial funding. The technology is developed and administered by the Uppsala Clinical Research Center. Since 2001, SCAAR has been internet based, with recording of data online through a web interface in the catheterisation laboratory; data are transferred in an encrypted format to a central server at the Uppsala Clinical Research Center. Long-term follow-up was obtained by merging the SCAAR database with other national registries based on all Swedish citizens’ unique personal identification number. Vital status and date of death was obtained from the National Population registry and was available until 20 May 2018. Because the data are anonymised, written informed consent from each patient was not needed;

Publisher Copyright:
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.


  • myocardial infarction
  • percutaneous coronary intervention
  • smokeless tobacco
  • snus

PubMed: MeSH publication types

  • Journal Article


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