Abstract 15528: Smoker's Paradox Refuted: No Beneficial Effects From Smoking Post Percutaneous Coronary Intervention for Acute ST-Segment Elevation Myocardial Infarction
Introduction: A paradoxical beneficial effect of smoking on long-term mortality has been observed in smokers compared to non-smokers receiving thrombolysis for acute ST-segment elevation myocardial infarction (STEMI). Because this has not been studied in the contemporary era of primary percutaneous coronary intervention (PPCI) for STEMI, we sought to examine cigarette smokers' post-infarction survival advantage after PPCI.
Methods: The study population was derived from the Aurora St. Luke's STEMI registry. The cohort consisted of consecutive STEMI patients who presented directly (non-transfer) to the emergency department within 12 hours of symptom onset between Jan. 2002 and June 2009 and were revascularized by PPCI as the choice reperfusion strategy. We analyzed baseline and angiographic characteristics in addition to clinical outcomes in smokers versus non-smokers. Effects of smoking were evaluated by logistic and Cox regression analysis after adjustment for baseline and clinical risk factors.
Results: A total of 908 patients (smokers, n=584 or 64.3%) formed the study cohort. Cigarette smokers compared to non-smokers were younger (median age 59 vs. 67 years), more often male (74% vs. 59%) and less likely to have diabetes (19.5% vs. 26.2% p=0.019), hypertension (51.5% vs. 61.4% p=0.004) and dyslipidemia (53.1% vs. 61.7% p=0.012). No differences were noted in infarct-related artery distribution, TIMI flow rates (pre and post) or type of stent used. When all univariate predictors of poor outcome were included as covariates in multivariate and Cox regression analysis, smoking status was not significantly associated with in-hospital mortality (relative risk=1.19, 95% confidence interval=0.77–1.84, p=0.443) or 3-year mortality (hazard ratio=1.09, 95% CI= 0.88–1.35, p=0.422).
Conclusions: No significant influence of habitual smoking on early or late mortality following STEMI was observed after successful revascularization by PPCI.
- © 2010 by American Heart Association, Inc.