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). Overall, a higher rate of continuous abstinence was observed in patients undergoing CABG than in those who had sustained an MI. Interestingly, the rates of abstinence were lower in subjects who used pharmacotherapy regardless of the intervention group (OR: 0.3; 95% CI: 0.2 to Seven first-line pharmacological treatments are available for smoking cessation therapy, including 5 nicotine- replacement therapies; the antidepressant bupropion; and varenicline, a partial agonist of the 4 2 subtype of the nicotinic acetylcholine receptor.659 661 The data supporting the use and timing of nicotine-replacement therapy after CABG are unclear. 