BACKGROUND: In smokers treated with fibrinolysis for ST-elevation myocardial infarction (STEMI) a paradoxical beneficial short-term outcome has been reported. This was attributed to favorable clinical and angiographic baseline variables and a better response to fibrinolysis. During follow-up infarct artery reocclusion is an important prognosticator. We studied the effects of smoking on reocclusion and long-term cardiac outcome after successful fibrinolysis. METHODS: In the Antithrombotics in the Prevention of Reocclusion In COronary Thrombolysis trials (APRICOT-1 and -2) 499 STEMI patients with an open infarct artery <48 h after fibrinolysis received randomizedantithrombotic treatment until 3-month follow-up angiography. Five-year clinical follow-up was complete. RESULTS: Current smokers (317 patients, 64%) had favorable clinical (age 54 vs. 60 years, P < 0.01) and angiographic (single vessel disease 61% vs. 49%, P = 0.02) baseline characteristics. Reocclusion rates were 21% (67/317) in smokers versus 32% (59/182) in non-smokers (P < 0.01). Five-year infarct-free cardiac survival did not differ: 82% vs. 85%. Reocclusion (HR 2.41, 95%CI 1.05-5.56, P = 0.04) independently predicted cardiac mortality. Smoking was independently associated with a reduced risk of reocclusion (OR 0.58, 95%CI 0.37-0.91, P = 0.02), but not with improved 5-year cardiac outcome (HR 1.34, 95%CI 0.79-2.25, P = ns). CONCLUSIONS: After successful fibrinolysis, smoking is independently associated with a more than 40% reduced risk of reocclusion, which is an independent predictor of adverse outcome. However, even with more favorable baseline characteristics smokers did not have improved 5-year cardiac outcome in this low-risk population.
RCT Entities:
BACKGROUND: In smokers treated with fibrinolysis for ST-elevation myocardial infarction (STEMI) a paradoxical beneficial short-term outcome has been reported. This was attributed to favorable clinical and angiographic baseline variables and a better response to fibrinolysis. During follow-up infarct artery reocclusion is an important prognosticator. We studied the effects of smoking on reocclusion and long-term cardiac outcome after successful fibrinolysis. METHODS: In the Antithrombotics in the Prevention of Reocclusion In COronary Thrombolysis trials (APRICOT-1 and -2) 499 STEMIpatients with an open infarct artery <48 h after fibrinolysis received randomized antithrombotic treatment until 3-month follow-up angiography. Five-year clinical follow-up was complete. RESULTS: Current smokers (317 patients, 64%) had favorable clinical (age 54 vs. 60 years, P < 0.01) and angiographic (single vessel disease 61% vs. 49%, P = 0.02) baseline characteristics. Reocclusion rates were 21% (67/317) in smokers versus 32% (59/182) in non-smokers (P < 0.01). Five-year infarct-free cardiac survival did not differ: 82% vs. 85%. Reocclusion (HR 2.41, 95%CI 1.05-5.56, P = 0.04) independently predicted cardiac mortality. Smoking was independently associated with a reduced risk of reocclusion (OR 0.58, 95%CI 0.37-0.91, P = 0.02), but not with improved 5-year cardiac outcome (HR 1.34, 95%CI 0.79-2.25, P = ns). CONCLUSIONS: After successful fibrinolysis, smoking is independently associated with a more than 40% reduced risk of reocclusion, which is an independent predictor of adverse outcome. However, even with more favorable baseline characteristics smokers did not have improved 5-year cardiac outcome in this low-risk population.
Authors: Jean-Philippe Collet; Gilles Montalescot; Michel Le May; Maria Borentain; Anthony Gershlick Journal: J Am Coll Cardiol Date: 2006-09-14 Impact factor: 24.094
Authors: E M Ohman; R M Califf; E J Topol; R Candela; C Abbottsmith; S Ellis; K N Sigmon; D Kereiakes; B George; R Stack Journal: Circulation Date: 1990-09 Impact factor: 29.690
Authors: J K French; C J Ellis; B J Webber; B F Williams; D J Amos; K Ramanathan; R M Whitlock; H D White Journal: Am J Cardiol Date: 1998-03-15 Impact factor: 2.778
Authors: Marc A Brouwer; Paul J P C van den Bergh; Wim R M Aengevaeren; Gerrit Veen; Hans E Luijten; Don P Hertzberger; Ad J van Boven; Ralf P J W Vromans; Gérard J H Uijen; Freek W A Verheugt Journal: Circulation Date: 2002-08-06 Impact factor: 29.690
Authors: C L Grines; E J Topol; W W O'Neill; B S George; D Kereiakes; H R Phillips; J D Leimberger; L H Woodlief; R M Califf Journal: Circulation Date: 1995-01-15 Impact factor: 29.690
Authors: E J Topol; R M Califf; B S George; D J Kereiakes; C W Abbottsmith; R J Candela; K L Lee; B Pitt; R S Stack; W W O'Neill Journal: N Engl J Med Date: 1987-09-03 Impact factor: 91.245