Impact of smoking status on outcomes of primary coronary intervention for acute myocardial infarction—The smoker's paradox revisited

We sought to determine the relationship between cigarette smoking and outcomes after mechanical reperfusion therapy in acute myocardial infarction (AMI). Prior studies have found that smokers with AMI have lower mortality rates and a more favorable response to fibrinolytic therapy than nonsmokers. T...

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Veröffentlicht in:The American heart journal 2005-08, Vol.150 (2), p.358-364
Hauptverfasser: Weisz, Giora, Cox, David A., Garcia, Eulogio, Tcheng, James E., Griffin, John J., Guagliumi, Giulio, Stuckey, Thomas D., Rutherford, Barry D., Mehran, Roxana, Aymong, Eve, Lansky, Alexandra, Grines, Cindy L., Stone, Gregg W.
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container_end_page 364
container_issue 2
container_start_page 358
container_title The American heart journal
container_volume 150
creator Weisz, Giora
Cox, David A.
Garcia, Eulogio
Tcheng, James E.
Griffin, John J.
Guagliumi, Giulio
Stuckey, Thomas D.
Rutherford, Barry D.
Mehran, Roxana
Aymong, Eve
Lansky, Alexandra
Grines, Cindy L.
Stone, Gregg W.
description We sought to determine the relationship between cigarette smoking and outcomes after mechanical reperfusion therapy in acute myocardial infarction (AMI). Prior studies have found that smokers with AMI have lower mortality rates and a more favorable response to fibrinolytic therapy than nonsmokers. The impact of cigarette smoking in patients undergoing primary percutaneous coronary intervention has not been examined. In the CADILLAC trial, 2082 patients with AMI were randomized to percutaneous transluminal coronary angioplasty ± abciximab versus stenting ± abciximab. Data on smoking status were prospectively collected and follow-up continued for 1 year. At the time of presentation, 638 (31%) patients had never smoked, 546 (26%) were former smokers, and 898 (45%) were currently smoking. In comparison to nonsmokers, current smokers were younger, more often men, and less frequently had diabetes, hypertension, prior AMI, and triple-vessel coronary disease. Procedural success rates were unrelated to smoking status. Mortality was lowest in current smokers, intermediate in former smokers, and highest in nonsmokers at 30 days (1.3% vs 1.7% vs 3.5%, respectively, P = .02) and 1 year (2.9% vs 3.7% vs 6.6%, P = .0008). After multivariate correction for differences in baseline variables, however, current smoking status was no longer protective from late mortality (hazard ratio 0.96, 95% CI 0.52-1.76, P = .89). The “smoker's paradox” extends to patients undergoing primary PCI for AMI, with increased survival seen in current smokers, an effect entirely explained by differences in baseline risk and not smoking status per se. The deleterious effects of smoking are expressed in the occurrence of AMI nearly a decade earlier than in nonsmokers, with similar age-adjusted risk, mandating intensive primary and secondary cigarette-cessation efforts.
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Prior studies have found that smokers with AMI have lower mortality rates and a more favorable response to fibrinolytic therapy than nonsmokers. The impact of cigarette smoking in patients undergoing primary percutaneous coronary intervention has not been examined. In the CADILLAC trial, 2082 patients with AMI were randomized to percutaneous transluminal coronary angioplasty ± abciximab versus stenting ± abciximab. Data on smoking status were prospectively collected and follow-up continued for 1 year. At the time of presentation, 638 (31%) patients had never smoked, 546 (26%) were former smokers, and 898 (45%) were currently smoking. In comparison to nonsmokers, current smokers were younger, more often men, and less frequently had diabetes, hypertension, prior AMI, and triple-vessel coronary disease. Procedural success rates were unrelated to smoking status. Mortality was lowest in current smokers, intermediate in former smokers, and highest in nonsmokers at 30 days (1.3% vs 1.7% vs 3.5%, respectively, P = .02) and 1 year (2.9% vs 3.7% vs 6.6%, P = .0008). After multivariate correction for differences in baseline variables, however, current smoking status was no longer protective from late mortality (hazard ratio 0.96, 95% CI 0.52-1.76, P = .89). The “smoker's paradox” extends to patients undergoing primary PCI for AMI, with increased survival seen in current smokers, an effect entirely explained by differences in baseline risk and not smoking status per se. 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subjects Aged
Angioplasty
Angioplasty, Balloon, Coronary
Antibodies, Monoclonal - therapeutic use
Anticoagulants - therapeutic use
Biological and medical sciences
Cardiology. Vascular system
Comorbidity
Coronary Angiography
Coronary heart disease
Coronary vessels
Drug therapy
Female
Follow-Up Studies
Heart
Heart attacks
Humans
Immunoglobulin Fab Fragments - therapeutic use
Male
Medical sciences
Middle Aged
Mortality
Myocardial Infarction - diagnostic imaging
Myocardial Infarction - therapy
Myocarditis. Cardiomyopathies
Platelet Aggregation Inhibitors - therapeutic use
Prospective Studies
Recurrence
Risk
Smoking - adverse effects
Smoking Cessation
Stents
Stroke - epidemiology
Survival Analysis
Tobacco, tobacco smoking
Toxicology
Treatment Outcome
title Impact of smoking status on outcomes of primary coronary intervention for acute myocardial infarction—The smoker's paradox revisited
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