Comparing Combination Therapy Arm (Varenicline with Varenicline Plus Counseling for acute coronary syndrome

Inclusion

• +Age ≥18 years;
• +Patients currently hospitalized or being discharged from hospital who have suffered an ACS, defined as follows:
• +i. MI, defined by positive troponin T, troponin I, or CK-MB levels (as defined by institution-specific cut-offs) and ≥ 1 of the following:
• +Ischemic symptoms for ≥ 20 min;
• +Electrocardiogram (ECG) changes indicative of ischemia (ST-segment elevation or depression);
• +Development of pathological Q waves on the ECG
• +ii. Unstable angina with significant coronary artery disease, defined by all of the following:
• +Ischemic symptoms for ≥ 20 min;
• +ECG changes indicative of ischemia (ST-segment changes);
• +At least one lesion ≥ 50% on angiogram performed during the current hospitalization.
• +Outpatients with the following diagnoses/conditions:
• +i. Cardiovascular:
• +Coronary artery disease documented with angiography or coronary CT;
• +Previous ACS, MI, stable or UA;
• +Previous coronary revascularization (e.g. PCI or CABG). ii. Renovascular:
• +a. Chronic kidney disease. iii. Cerebrovascular:
• +a. Previous cerebral infarction or transient cerebral ischemic attack. iv. Peripheral vascular:
• +Ankle-brachial pressure index of \< 0.9 or intermittent claudication;
• +Documented carotid artery disease;
• +Lower-limb amputation;
• +v. ≥1 risk factors:
• +BMI ≥ 27 kg/m2;
• +Dyslipidemia;
• +Family history (first degree relative: parents or siblings only) of coronary heart disease or stroke before the age of 60 years;
• +Hypertension;
• +Males aged ≥ 55 years/females aged ≥ 60 years;
• +Diabetes mellitus. vi. Heart-related conditions:
• +Atrial fibrillation or flutter;
• +Cardiomyopathy;
• +Heart failure;
• +Left ventricular hypertrophy (evidenced by echocardiography or ECG);
• +Valvular disease (evidenced by echocardiography).
• +Able to understand and provide informed consentInformed consentThe process of being told what taking part involves, then choosing freely.Read more → in English or French;
• +Likely to be available for 52 weeks of follow-upFollow-upContinued check-ins after the treatment part is finished.Read more →.
• +\[Note: patients who undergo cardiac catheterization or percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery will be eligible provided they are able to start varenicline in-hospital and nicotine e-cigarette at discharge.\]
• +Abdominal aortic aneurysm \> 3.0 cm or previous aortic aneurysm surgery;
• +Previous lower-limb bypass surgery or angioplasty.
• +Smoked on average ≥ conventional cigarettes/day for the past year;
• +Motivated to quit smoking according to the Motivation To Stop Scale (MTSS) (≥ level 5);
• +If randomizedRandomisedWhich group you go into is decided by chance, not by you or your doctor.Read more → to the combination armArmOne of the groups in a study, each receiving something different.Read more → (varenicline and e-cigarette plus counseling), willing and able to purchase e-cigarettes with the following properties: rechargeable, closed system that uses sealed cartridges or pods, tobacco or no flavor only, and nicotine strength of 20 mg/ml (2%) or less;