Abstract 14706: The Impact of Smoking on Short- and Long-Term Outcomes in NSTEMI Results from 38,628 Patients from the CRUSADE Registry
Introduction Smoking tobacco is a known risk factor for coronary disease yet prior studies have found that smokers have observed paradoxically favorable short-term outcomes after acute coronary syndromes (ACS). Yet there is limited contemporary result as well as the long term implications of smoking.
Methods We identified 38,628 NSTEMI patients (4876 current/recent smokers and 33,752 non-smokers) over age 65 years in the CRUSADE registry from 445 hospitals between February 2003 and December 2006. Baseline clinical data were linked to Medicare claims data for longitudinal outcomes. Cox proportional hazards models were used to examine the association of smoking with 30-day mortality and long-term mortality.
Results Smokers were younger (median age 72 vs. 79 years, p<0.001), were more likely to be male (58% vs. 51%, p<0.001), were less likely to have a medical history of hypertension, diabetes mellitus, and renal insufficiency, and were more likely to receive in-hospital revascularization (PCI or CABG) compared with non-smokers (all p<0.001). The unadjusted 30-day mortality was lower for smokers (8.7% vs. 10.3%, p=0.0004), but this did not persist after adjustment for baseline clinical features (adjusted HR 1.08, 95% CI 0.97-1.20). Over a median of 3.6 years of follow up, smokers continued to have lower crude mortality rates (34.00% vs. 35.83% at 3 years, p=0.0009). However, after adjustment, smoking was associated with significantly long term higher mortality risk (adjusted HR 1.28, 95% CI 1.21-1.34) (Figure).
Conclusions As observed in prior studies, we observed paradoxically lower crude mortality among smokers after ACS. However, after adjustment for clinical factors it is clear that longitudinal outcomes are worse for smokers relative to non-smokers. These results support the benefits of smoking cessation following NSTEMI even among older individuals.
- © 2012 by American Heart Association, Inc.