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Original research
Smokeless tobacco, snus, at admission for percutaneous coronary intervention and future risk for cardiac events
  1. Ole Frobert1,
  2. Christian Reitan2,
  3. Dorothy K Hatsukami3,
  4. John Pernow4,
  5. Elmir Omerovic5 and
  6. Pontus Andell6
  1. 1Faculty of Health, Department of Cardiology, Örebro University, Örebro, Sweden
  2. 2Faculty of Medicine, Department of Cardiology, Lund University, Lund, Sweden
  3. 3Department of Psychiatry, Tobacco Research Programs, University of Minnesota, Minneapolis, Minnesota, USA
  4. 4Unit of Cardiology, Department of Medicine, Heart and Vascular Division, Karolinska Institutet, Stockholm, Sweden
  5. 5Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
  6. 6Unit of Cardiology, Department of Medicine, Heart and Vascular Division, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Dr Ole Frobert; ole.frobert{at}


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.

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

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  • Contributors OF, CR and PA conceptualised the study. CR and PA performed statistical analyses. OF wrote initial manuscript draft. CR, DKH, JP, EO and PA commented on manuscript and revisions.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available.

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