The impact of smoking on mortality after acute ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: a retrospective cohort outcome study at 3 years.
Lloyd SteeleJames PalmerAmelia LloydJames FotheringhamJavaid IqbalEver D GrechPublished in: Journal of thrombosis and thrombolysis (2019)
The "smoker's paradox", where smokers have improved survival post-myocardial infarction, was predominantly observed in the thrombolytic era. However, evidence for the smoker's paradox in the current era of PCI therapy is both limited and inconsistent. We aimed to examine the effect of smoking status on survival in unselected ST-elevation myocardial infarction (STEMI) patients managed by primary percutaneous coronary intervention (PCI). Data were collected for all patients with acute STEMI undergoing primary PCI at The South Yorkshire Cardiothoracic Centre, UK over a 5-year period between 2009 and 2014. Differences in survival by smoking status were assessed before and after adjustment for differences in baseline variables using a Kaplan-Meier curve and a Cox regression analysis, respectively. A total of 3133 STEMI patients were included in the study. After adjustment for differences in baseline variables, smoking was associated with a significantly increased mortality (hazard ratio 1.35 (95% CI 1.04-1.74)) compared to never smokers after 3 years. The risk for ex-smokers (hazard ratio 0.99 (0.76-1.28)) was similar to never smokers. There were no significant differences in survival by smoking status at 30 days and 1 year. In this large registry of STEMI patients managed by primary PCI, smokers had a significantly higher 3-year mortality than non-smokers. This study is the first to not only dispel the existence of the smoker's paradox, but to highlight a high-risk subgroup who may warrant tailored secondary prevention treatment, including smoking cessation.
Keyphrases
- percutaneous coronary intervention
- smoking cessation
- st segment elevation myocardial infarction
- st elevation myocardial infarction
- acute coronary syndrome
- acute myocardial infarction
- antiplatelet therapy
- coronary artery disease
- coronary artery bypass grafting
- replacement therapy
- end stage renal disease
- newly diagnosed
- atrial fibrillation
- chronic kidney disease
- ejection fraction
- cardiovascular events
- heart failure
- coronary artery bypass
- clinical trial
- cross sectional
- peritoneal dialysis
- risk factors
- stem cells
- machine learning
- cardiovascular disease
- pulmonary embolism
- free survival
- acute ischemic stroke