Sebastian J Reinstadler1,2,3, Charlotte Eitel1,2, Georg Fuernau1,2, Suzanne de Waha1,2, Steffen Desch1,2, Meinhard Mende4, Bernhard Metzler3, Gerhard Schuler5, Holger Thiele1,2, Ingo Eitel6,2. 1. University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology, and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany. 2. German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany. 3. University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck 6020, Austria. 4. Clinical Trial Center Leipzig, University of Leipzig, Leipzig 04289, Germany. 5. Department of Cardiology, Heart Center University Leipzig, Leipzig 04289, Germany. 6. University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology, and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany ingoeitel@gmx.de.
Abstract
AIMS: There is evidence suggesting a positive effect of cigarette smoking on myocardial tissue reperfusion and clinical outcomes in patients with myocardial infarction ('smoker's paradox'). We aimed to evaluate the relationship of smoking with cardiac magnetic resonance (CMR)-determined myocardial salvage and damage as well as clinical outcomes in patients undergoing primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS: This multicentre study included 727 consecutive STEMI patients reperfused within 12 h after symptom onset. CMR imaging parameters [area at risk (AAR), infarct size (IS), myocardial salvage index (MSI), and microvascular obstruction (MVO) and intramyocardial haemorrhage (IMH)] were compared according to admission smoking status. Major adverse cardiac event (MACE) rates at 12 months after infarction were compared between groups. Three hundred and thirty-nine (46.6%) patients were current smokers. There was no difference in the extent of AAR [35 (24-47) vs. 37 (27-49) % of left ventricular volume (LV), P = 0.10], IS [16 (8-25) vs. 17 (10-26) %LV, P = 0.21], MSI [53 (29-70) vs. 52 (34-71), P = 0.47], MVO [0 (0-1.7) vs. 0 (0-1.6) %LV, P = 0.91], or in the frequency of IMH (42 vs. 39%, P = 0.58) between smokers and non-smokers. Smokers had lower MACE (3.8 vs. 8.2%, P = 0.01) rates. However, adjustment for differences in baseline risk factors attenuated the association of smoking with MACE markedly (hazard ratio = 0.71, 95% confidence interval 0.36-1.38, P = 0.31). CONCLUSION: Smoking is not associated with PPCI efficacy (myocardial salvage) or irreversible myocardial damage in patients with STEMI. The lower MACE rate of smokers was entirely explained by differences in baseline risk characteristics, thus challenging the existence of a smoker's paradox. Published on behalf of the European Society of Cardiology. All rights reserved.
RCT Entities:
AIMS: There is evidence suggesting a positive effect of cigarette smoking on myocardial tissue reperfusion and clinical outcomes in patients with myocardial infarction ('smoker's paradox'). We aimed to evaluate the relationship of smoking with cardiac magnetic resonance (CMR)-determined myocardial salvage and damage as well as clinical outcomes in patients undergoing primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS: This multicentre study included 727 consecutive STEMI patients reperfused within 12 h after symptom onset. CMR imaging parameters [area at risk (AAR), infarct size (IS), myocardial salvage index (MSI), and microvascular obstruction (MVO) and intramyocardial haemorrhage (IMH)] were compared according to admission smoking status. Major adverse cardiac event (MACE) rates at 12 months after infarction were compared between groups. Three hundred and thirty-nine (46.6%) patients were current smokers. There was no difference in the extent of AAR [35 (24-47) vs. 37 (27-49) % of left ventricular volume (LV), P = 0.10], IS [16 (8-25) vs. 17 (10-26) %LV, P = 0.21], MSI [53 (29-70) vs. 52 (34-71), P = 0.47], MVO [0 (0-1.7) vs. 0 (0-1.6) %LV, P = 0.91], or in the frequency of IMH (42 vs. 39%, P = 0.58) between smokers and non-smokers. Smokers had lower MACE (3.8 vs. 8.2%, P = 0.01) rates. However, adjustment for differences in baseline risk factors attenuated the association of smoking with MACE markedly (hazard ratio = 0.71, 95% confidence interval 0.36-1.38, P = 0.31). CONCLUSION: Smoking is not associated with PPCI efficacy (myocardial salvage) or irreversible myocardial damage in patients with STEMI. The lower MACE rate of smokers was entirely explained by differences in baseline risk characteristics, thus challenging the existence of a smoker's paradox. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Martin Reindl; Sebastian Johannes Reinstadler; Christina Tiller; Hans-Josef Feistritzer; Markus Kofler; Alexandra Brix; Agnes Mayr; Gert Klug; Bernhard Metzler Journal: Eur Radiol Date: 2018-12-13 Impact factor: 5.315
Authors: David Carrick; Caroline Haig; Annette M Maznyczka; Jaclyn Carberry; Kenneth Mangion; Nadeem Ahmed; Vannesa Teng Yue May; Margaret McEntegart; Mark C Petrie; Hany Eteiba; Mitchell Lindsay; Stuart Hood; Stuart Watkins; Andrew Davie; Ahmed Mahrous; Ify Mordi; Ian Ford; Aleksandra Radjenovic; Paul Welsh; Naveed Sattar; Kirsty Wetherall; Keith G Oldroyd; Colin Berry Journal: Hypertension Date: 2018-09 Impact factor: 10.190
Authors: Caroline Haig; David Carrick; Jaclyn Carberry; Kenneth Mangion; Annette Maznyczka; Kirsty Wetherall; Margaret McEntegart; Mark C Petrie; Hany Eteiba; Mitchell Lindsay; Stuart Hood; Stuart Watkins; Andrew Davie; Ahmed Mahrous; Ify Mordi; Nadeem Ahmed; Vannesa Teng Yue May; Ian Ford; Aleksandra Radjenovic; Paul Welsh; Naveed Sattar; Keith G Oldroyd; Colin Berry Journal: JACC Cardiovasc Imaging Date: 2018-07-18
Authors: Lara S F Konijnenberg; Peter Damman; Dirk J Duncker; Robert A Kloner; Robin Nijveldt; Robert-Jan M van Geuns; Colin Berry; Niels P Riksen; Javier Escaned; Niels van Royen Journal: Cardiovasc Res Date: 2020-03-01 Impact factor: 10.787