Abstract 19021: Relationship Between Smoker’s Paradox and P2y12 Receptor Inhibition Therapy in Patients With St-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: A Novel Insight into a Persisting Paradox
Introduction: Recent studies have shown that active smokers undergoing primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI) have lower in-hospital mortality than non-smokers (smoker’s paradox). The interplay between smoking status, clopidogrel and potent P2Y12 inhibitors on clinical outcomes remains unclear.
Methods: We analyzed data from a large, nationwide, prospective, multicenter registry of patients admitted with acute coronary syndrome in Switzerland (AMIS). Patients undergoing pPCI for STEMI <12 hours of symptom onset were included. Multivariable logistic regression was used to compare in-hospital mortality between current and non-smokers according to P2Y12 receptor inhibitor therapy.
Results: Between February 2008 and January 2016, 4271 patients (1725 active smokers, 40.4%) were included. Compared with patients on prasugrel (n=1541) or ticagrelor (n=1249), patients treated with clopidogrel (n=1’481) were older, with higher cardiovascular risk profile and longer reperfusion delays, but were less likely active smokers (p<0.05 for all). Overall in-hospital death occurred in 157 patients (3.7%). On univariate analysis, clopidogrel use and active smoking were respectively associated with higher (OR 2.12, 95%CI 1.54-2.92, p<0.001) and lower (OR 0.40, 95%CI 0.27-0.58, p<0.001) in-hospital mortality rates. Clopidogrel use was associated with increased risk of mortality in both current (OR 2.18, 95%CI 1.10-4.34, p=0.026) and non-smokers (OR 1.86, 95%CI 1.30-2.67, p=0.001). No statistical interaction was found between the two covariates (p=0.68). On multivariate analysis, active smoking (OR 0.55, 95%CI 0.34-0.88, p=0.012) but not clopidogrel use was associated with lower in-hospital mortality after correction for prognostic factors including age, gender, Killip class, time-to-pPCI and renal failure.
Conclusion: In a large prospective cohort of STEMI patients undergoing pPCI, we observed significantly lower risk-adjusted in-hospital mortality in active smokers than in non-smokers, regardless of P2Y12 receptor inhibition therapy. Our data suggest that the paradoxical beneficial effect of active smoking is not associated with the level of P2Y12 receptor inhibition.
Author Disclosures: P. Masci: None. S. Degrauwe: None. O. Muller: None. E. Eeckhout: None. D. Radovanovic: None. P. Erne: None. J. Iglesias: None.
- © 2016 by American Heart Association, Inc.