Background This study was designed to describe the impact of smoking on health status and mortality after percutaneous coronary intervention (PCI). Methods A cohort of 271 consecutive PCI patients at the Mid-America Heart Institute of St Luke's Hospital in Kansas City, Mo, were observed in a prospective, observational study. Surveys that included health status assessments were administered at baseline and at 6 and 12 months after intervention. Primary outcome was health status as measured by the Short Form-12 (SF-12) and the Seattle Angina Questionnaire (SAQ). Results Risk-adjusted statistical models demonstrated that, across a number of health-related quality of life domains, patients who were current smokers had poorer health status outcomes than other patients after revascularization. For instance, patients who had never smoked (P < .001) and patients who were former smokers (P < .001) scored significantly higher than patients who were current smokers on the physical component score of the SF-12, which indicated a better sense of overall physical function. Similarly, patients who had never smoked and patients who were former smokers reported significantly fewer physical limitations, less angina, and a higher quality of life on the SAQ than patients who were current smokers. Smoking status was unrelated to mortality rate in the 12 months after revascularization. Conclusions Smoking substantially limits the potential health status benefits of PCI. (Am Heart J 2003;145:652-7.)