Smoking is a powerful independent predictor of sudden cardiac death in patients with CAD (HR: 2.47; 95% CI: 1.46 to 4.19). It has been associated with accelerated disease and occlusion of SVGs as well as endothelial dysfunction of arterial grafts.651 653 Compared with nonsmokers, subjects who are smoking at the time of CABG more often have pulmonary complications that require prolonged postopera- tive intubation and a longer ICU stay as well as postoperative infections.654 656 Even smokers who quit just before CABG have fewer postoperative complications than those who continued to smoke.654 As a result, all smokers referred for CABG should be counseled to quit smoking before surgery. Smoking cessation seems to be especially beneficial for patients hospitalized with ACS who then require CABG.644,657 Independent predictors of continued nonsmok- ing 1 year after CABG included 3 previous attempts to quit nonsmoking (OR: 10.0; 95% CI: 2.0 to 50), a definite intention to quit smoking (OR: 12.0; 95% CI: 2.6 to 55.1), and no difficulty with smoking cessation while in the hospital cessation intervention directed at patients early after post- CABG discharge appears to be more effective than a conser- vative approach.642 In a systematic review of 33 trials of smoking cessation, counseling that began during hospitaliza- tion and included supportive contacts for 1 month after hospital discharge increased the rates of smoking cessation (OR: 1.65; 95% CI: 1.44 to 1.90), whereas the use of pharmacotherapy did not improve abstinence rates.643 These findings are supported by a 2009 RCT comparing intensive or minimal smoking cessation intervention in patients hospital- ized for CABG or acute MI.644 In this trial, the 12-month self-reported rate of abstinence was 62% among patients randomly assigned to the intensive program and 46% among those randomly allocated to the minimal intervention (OR: 2.0; 95% CI: 1.2 to 3.1). 