What is the impact of smoking status on CABG outcomes and graft patency?

• A. Active smoking improves outcomes
• B. Smoking status is irrelevant
• C. Active smoking worsens outcomes but cessation improves
• D. Smoking cessation has no effect

Answer: (C)

Active smoking introduces factors that worsen both the perioperative course and the long-term success of grafts. Nicotine and other smoke constituents cause vasoconstriction, increased heart rate, and a higher tendency for platelet aggregation, which raise the risk of graft thrombosis and early occlusion. They also impair oxygen delivery, promote inflammation, and hinder wound healing, leading to more pulmonary complications, infections, and longer hospital stays after CABG. Quitting before surgery reduces these risks: improved oxygen carrying capacity, better endothelial function, and a less thrombogenic environment help protect graft patency and overall outcomes. When patients stop smoking, they typically experience better short-term recovery and improved long-term graft durability, whereas continuing to smoke maintains higher risk.