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Impact of Smoking Status on Mortality in STEMI Patients Undergoing Mechanical Reperfusion for STEMI: Insights from the ISACS-STEMI COVID-19 Registry.

Giuseppe De LucaMagdy AlgowharyBerat UguzDinaldo C OliveiraVladimir GanyukovZan ZimbakovMiha CercekLisette Okkels JensenPoay Huan LohLucian CâlmâcGerard Roura I FerrerAlexandre QuadrosMarek MilewskiFortunato Scotto D'UccioClemens von BirgelenFrancesco VersaciJurrien Ten BergGianni CasellaAaron Wong Sung LungPetr KalaJosé Luis Díez GilXavier CarrilloMaurits DirksenVictor M Becerra-MunozMichael Kang-Yin LeeDafsah Arifa JuzarRodrigo de Moura JoaquimRoberto PaladinoDavor MilicicPeriklis DavlourosNikola BakraceskiFilippo ZilioLuca DonazzanAdriaan KraaijeveldGennaro GalassoLux ArpadMarinucci LuciaVincenzo GuiducciMaurizio MenichelliAlessandra ScocciaAylin Hatice YamacKadir Uğur MertXacobe Flores RiosTomas KovarnikMichal KidawaJosè MoreuFlavien VincentEnrico FabrisIñigo Lozano Martínez-LuengasMarco BoccalatteFrancisco Bosa OjedaCarlos Arellano-SerranoGianluca CaiazzoGiuseppe CirrincioneHsien-Li KaoJuan Sanchis ForésLuigi VignaliHelder PereiraStephane ManzoSantiago OrdoñezAlev Arat ÖzkanBruno SchellerHeidi LehtolaRui Campante TelesChristos MantisYlitalo AnttiJoão António Brum SilveiraRodrigo ZoniIvan BessonovStefano SavonittoGeorge KochiadakisDimitrios AlexopulosCarlos E UribeJohn KanakakisBenjamin FaurieGabriele GabrielliAlejandro Gutierrez BarriosJuan Pablo BachiniAlex RochaFrankie Chor-Cheung TamAlfredo RodriguezAntonia Anna LukitoVeauthyelau Saint-JoyGustavo PessahAndrea TuccilloGiuliana CorteseGuido ParodiMohammed Abed BurgadhaElvin KedhiPablo LamelasHarry SuryapranataMatteo NardinMonica Verdoia
Published in: Journal of clinical medicine (2022)
The so-called "smoking paradox", conditioning lower mortality in smokers among STEMI patients, has seldom been addressed in the settings of modern primary PCI protocols. The ISACS-STEMI COVID-19 is a large-scale retrospective multicenter registry addressing in-hospital mortality, reperfusion, and 30-day mortality among primary PCI patients in the era of the COVID-19 pandemic. Among the 16,083 STEMI patients, 6819 (42.3%) patients were active smokers, 2099 (13.1%) previous smokers, and 7165 (44.6%) non-smokers. Despite the impaired preprocedural recanalization ( p < 0.001), active smokers had a significantly better postprocedural TIMI flow compared with non-smokers ( p < 0.001); this was confirmed after adjustment for all baseline and procedural confounders, and the propensity score. Active smokers had a significantly lower in-hospital ( p < 0.001) and 30-day ( p < 0.001) mortality compared with non-smokers and previous smokers; this was confirmed after adjustment for all baseline and procedural confounders, and the propensity score. In conclusion, in our population, active smoking was significantly associated with improved epicardial recanalization and lower in-hospital and 30-day mortality compared with previous and non-smoking history.
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