Björn Redfors1, Ariel Furer2, Harry P Selker3, Holger Thiele4, Manesh R Patel5, Shmuel Chen6, James E Udelson7, E Magnus Ohman5, Ingo Eitel8, Christopher B Granger5, Akiko Maehara6, Ajay J Kirtane6, Philippe Généreux9, Paul L Jenkins10, Ori Ben-Yehuda6, Gregg W Stone11. 1. Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Department of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden. 2. Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Medical Corps, Israel Defense Forces, Tel Hashomer, Israel; Department of Military Medicine, Hebrew University Hadassah School of Medicine, Jerusalem, Israel. 3. Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts. 4. Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany. 5. Division of Cardiology, Duke University Medical Center, Durham, North Carolina. 6. Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Department of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York. 7. Division of Cardiology, Tufts Medical Center, Boston, Massachusetts. 8. University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany. 9. Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey; Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada. 10. Mary Imogene Bassett Hospital, Cooperstown, New York. 11. Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: gregg.stone@mountsinai.org.
Abstract
BACKGROUND: Smoking is a well-established risk factor for ST-segment elevation myocardial infarction (STEMI); however, once STEMI occurs, smoking has been associated with favorable short-term outcomes, an observation termed the "smoker's paradox." It has been postulated that smoking might exert protective effects that could reduce infarct size, a strong independent predictor of worse outcomes after STEMI. OBJECTIVES: The purpose of this study was to determine the relationship among smoking, infarct size, microvascular obstruction (MVO), and adverse outcomes after STEMI. METHODS: Individual patient-data were pooled from 10 randomized trials of patients with STEMI undergoing primary percutaneous coronary intervention. Infarct size was assessed at median 4 days by either cardiac magnetic resonance imaging or technetium-99m sestamibi single-photon emission computed tomography. Multivariable analysis was used to assess the relationship between smoking, infarct size, and the 1-year rates of death or heart failure (HF) hospitalization and reinfarction. RESULTS: Among 2,564 patients with STEMI, 1,093 (42.6%) were recent smokers. Smokers were 10 years younger and had fewer comorbidities. Infarct size was similar in smokers and nonsmokers (adjusted difference: 0.0%; 95% confidence interval [CI]: -3.3% to 3.3%; p = 0.99). Nor was the extent of MVO different between smokers and nonsmokers. Smokers had lower crude 1-year rates of all-cause death (1.0% vs. 2.9%; p < 0.001) and death or HF hospitalization (3.3% vs. 5.1%; p = 0.009) with similar rates of reinfarction. After adjustment for age and other risk factors, smokers had a similar 1-year risk of death (adjusted hazard ratio [adjHR]: 0.92; 95% CI: 0.46 to 1.84) and higher risks of death or HF hospitalization (adjHR: 1.49; 95% CI: 1.09 to 2.02) as well as reinfarction (adjHR: 1.97; 95% CI: 1.17 to 3.33). CONCLUSIONS: In the present large-scale individual patient-data pooled analysis, recent smoking was unrelated to infarct size or MVO, but was associated with a worse prognosis after primary PCI in STEMI. The smoker's paradox may be explained by the younger age and fewer cardiovascular risk factors in smokers compared with nonsmokers.
BACKGROUND: Smoking is a well-established risk factor for ST-segment elevation myocardial infarction (STEMI); however, once STEMI occurs, smoking has been associated with favorable short-term outcomes, an observation termed the "smoker's paradox." It has been postulated that smoking might exert protective effects that could reduce infarct size, a strong independent predictor of worse outcomes after STEMI. OBJECTIVES: The purpose of this study was to determine the relationship among smoking, infarct size, microvascular obstruction (MVO), and adverse outcomes after STEMI. METHODS: Individual patient-data were pooled from 10 randomized trials of patients with STEMI undergoing primary percutaneous coronary intervention. Infarct size was assessed at median 4 days by either cardiac magnetic resonance imaging or technetium-99m sestamibi single-photon emission computed tomography. Multivariable analysis was used to assess the relationship between smoking, infarct size, and the 1-year rates of death or heart failure (HF) hospitalization and reinfarction. RESULTS: Among 2,564 patients with STEMI, 1,093 (42.6%) were recent smokers. Smokers were 10 years younger and had fewer comorbidities. Infarct size was similar in smokers and nonsmokers (adjusted difference: 0.0%; 95% confidence interval [CI]: -3.3% to 3.3%; p = 0.99). Nor was the extent of MVO different between smokers and nonsmokers. Smokers had lower crude 1-year rates of all-cause death (1.0% vs. 2.9%; p < 0.001) and death or HF hospitalization (3.3% vs. 5.1%; p = 0.009) with similar rates of reinfarction. After adjustment for age and other risk factors, smokers had a similar 1-year risk of death (adjusted hazard ratio [adjHR]: 0.92; 95% CI: 0.46 to 1.84) and higher risks of death or HF hospitalization (adjHR: 1.49; 95% CI: 1.09 to 2.02) as well as reinfarction (adjHR: 1.97; 95% CI: 1.17 to 3.33). CONCLUSIONS: In the present large-scale individual patient-data pooled analysis, recent smoking was unrelated to infarct size or MVO, but was associated with a worse prognosis after primary PCI in STEMI. The smoker's paradox may be explained by the younger age and fewer cardiovascular risk factors in smokers compared with nonsmokers.
Authors: Won Young Jang; Su Nam Lee; Sung-Ho Her; Donggyu Moon; Keon-Woong Moon; Ki-Dong Yoo; Kyusup Lee; Ik Jun Choi; Jae Hwan Lee; Jang Hoon Lee; Sang Rok Lee; Seung-Wan Lee; Kyeong Ho Yun; Hyun-Jong Lee Journal: Ann Saudi Med Date: 2021-08-22 Impact factor: 1.526
Authors: Su Nam Lee; Ik Jun Choi; Sungmin Lim; Eun Ho Choo; Byung Hee Hwang; Chan Joon Kim; Mahn Won Park; Jong Min Lee; Chul Soo Park; Hee Yeol Kim; Ki Dong Yoo; Doo Soo Jeon; Ho Joong Youn; Wook Sung Chung; Min Chul Kim; Myung Ho Jeong; Youngkeun Ahn; Kiyuk Chang Journal: Korean Circ J Date: 2021-04 Impact factor: 3.101