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 |
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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. |
doi_str_mv | 10.1016/j.ahj.2004.01.032 |
format | Article |
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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. 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.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2004.01.032</identifier><identifier>PMID: 16086943</identifier><identifier>CODEN: AHJOA2</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>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</subject><ispartof>The American heart journal, 2005-08, Vol.150 (2), p.358-364</ispartof><rights>2005 Mosby, Inc.</rights><rights>2005 INIST-CNRS</rights><rights>Copyright Elsevier Limited Aug 2005</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c475t-dfec5f2263d07a6e0af064428bf119dfc7901739307f3af7b22fbf798713bb8f3</citedby><cites>FETCH-LOGICAL-c475t-dfec5f2263d07a6e0af064428bf119dfc7901739307f3af7b22fbf798713bb8f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1504622281?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>315,781,785,3551,27929,27930,46000,64390,64392,64394,72474</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17079134$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16086943$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Weisz, Giora</creatorcontrib><creatorcontrib>Cox, David A.</creatorcontrib><creatorcontrib>Garcia, Eulogio</creatorcontrib><creatorcontrib>Tcheng, James E.</creatorcontrib><creatorcontrib>Griffin, John J.</creatorcontrib><creatorcontrib>Guagliumi, Giulio</creatorcontrib><creatorcontrib>Stuckey, Thomas D.</creatorcontrib><creatorcontrib>Rutherford, Barry D.</creatorcontrib><creatorcontrib>Mehran, Roxana</creatorcontrib><creatorcontrib>Aymong, Eve</creatorcontrib><creatorcontrib>Lansky, Alexandra</creatorcontrib><creatorcontrib>Grines, Cindy L.</creatorcontrib><creatorcontrib>Stone, Gregg W.</creatorcontrib><title>Impact of smoking status on outcomes of primary coronary intervention for acute myocardial infarction—The smoker's paradox revisited</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><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.</description><subject>Aged</subject><subject>Angioplasty</subject><subject>Angioplasty, Balloon, Coronary</subject><subject>Antibodies, Monoclonal - therapeutic use</subject><subject>Anticoagulants - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Comorbidity</subject><subject>Coronary Angiography</subject><subject>Coronary heart disease</subject><subject>Coronary vessels</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Immunoglobulin Fab Fragments - therapeutic use</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Myocardial Infarction - diagnostic imaging</subject><subject>Myocardial Infarction - therapy</subject><subject>Myocarditis. Cardiomyopathies</subject><subject>Platelet Aggregation Inhibitors - therapeutic use</subject><subject>Prospective Studies</subject><subject>Recurrence</subject><subject>Risk</subject><subject>Smoking - adverse effects</subject><subject>Smoking Cessation</subject><subject>Stents</subject><subject>Stroke - epidemiology</subject><subject>Survival Analysis</subject><subject>Tobacco, tobacco smoking</subject><subject>Toxicology</subject><subject>Treatment Outcome</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kc2K1TAUgIMoznX0AdxIQdRV60mam7S4ksGfgQE34zqk6YmT2jbXJL04O1c-gU_ok5h6CwMuXOWE850fzkfIUwoVBSpeD5W-GSoGwCugFdTsHtlRaGUpJOf3yQ4AWNlIqM_IoxiH_BWsEQ_JGRXQiJbXO_Lzcjpokwpvizj5r27-UsSk0xILPxd-ScZPGNfsIbhJh9vC-ODnNXBzwnDEOblMWh8KbZaExXTrjQ6902MmrA5mzf_-8ev6Bv9OwPAqFgcddO-_FwGPLrqE_WPywOox4pPtPSef37-7vvhYXn36cHnx9qo0XO5T2Vs0e8uYqHuQWiBoC4Jz1nSW0ra3RrZAZd3WIG2trewYs52VbSNp3XWNrc_Jy1PfQ_DfFoxJTS4aHEc9o1-iEg3fC0FFBp__Aw5-CXPeTdE9cMEYa2im6IkywccY0KrtTIqCWhWpQWVFalWkgKqsKNc82zov3YT9XcXmJAMvNkBHo0cb9GxcvOMkyJbWPHNvThzmgx0dBhWNw9lg7wKapHrv_rPGH80Esdc</recordid><startdate>20050801</startdate><enddate>20050801</enddate><creator>Weisz, Giora</creator><creator>Cox, David A.</creator><creator>Garcia, Eulogio</creator><creator>Tcheng, James E.</creator><creator>Griffin, John J.</creator><creator>Guagliumi, Giulio</creator><creator>Stuckey, Thomas D.</creator><creator>Rutherford, Barry D.</creator><creator>Mehran, Roxana</creator><creator>Aymong, Eve</creator><creator>Lansky, Alexandra</creator><creator>Grines, Cindy L.</creator><creator>Stone, Gregg W.</creator><general>Mosby, Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20050801</creationdate><title>Impact of smoking status on outcomes of primary coronary intervention for acute myocardial infarction—The smoker's paradox revisited</title><author>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.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c475t-dfec5f2263d07a6e0af064428bf119dfc7901739307f3af7b22fbf798713bb8f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Aged</topic><topic>Angioplasty</topic><topic>Angioplasty, Balloon, Coronary</topic><topic>Antibodies, Monoclonal - therapeutic use</topic><topic>Anticoagulants - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Comorbidity</topic><topic>Coronary Angiography</topic><topic>Coronary heart disease</topic><topic>Coronary vessels</topic><topic>Drug therapy</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Immunoglobulin Fab Fragments - therapeutic use</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Myocardial Infarction - diagnostic imaging</topic><topic>Myocardial Infarction - therapy</topic><topic>Myocarditis. Cardiomyopathies</topic><topic>Platelet Aggregation Inhibitors - therapeutic use</topic><topic>Prospective Studies</topic><topic>Recurrence</topic><topic>Risk</topic><topic>Smoking - adverse effects</topic><topic>Smoking Cessation</topic><topic>Stents</topic><topic>Stroke - epidemiology</topic><topic>Survival Analysis</topic><topic>Tobacco, tobacco smoking</topic><topic>Toxicology</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Weisz, Giora</creatorcontrib><creatorcontrib>Cox, David A.</creatorcontrib><creatorcontrib>Garcia, Eulogio</creatorcontrib><creatorcontrib>Tcheng, James E.</creatorcontrib><creatorcontrib>Griffin, John J.</creatorcontrib><creatorcontrib>Guagliumi, Giulio</creatorcontrib><creatorcontrib>Stuckey, Thomas D.</creatorcontrib><creatorcontrib>Rutherford, Barry D.</creatorcontrib><creatorcontrib>Mehran, Roxana</creatorcontrib><creatorcontrib>Aymong, Eve</creatorcontrib><creatorcontrib>Lansky, Alexandra</creatorcontrib><creatorcontrib>Grines, Cindy L.</creatorcontrib><creatorcontrib>Stone, Gregg W.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Weisz, Giora</au><au>Cox, David A.</au><au>Garcia, Eulogio</au><au>Tcheng, James E.</au><au>Griffin, John J.</au><au>Guagliumi, Giulio</au><au>Stuckey, Thomas D.</au><au>Rutherford, Barry D.</au><au>Mehran, Roxana</au><au>Aymong, Eve</au><au>Lansky, Alexandra</au><au>Grines, Cindy L.</au><au>Stone, Gregg W.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of smoking status on outcomes of primary coronary intervention for acute myocardial infarction—The smoker's paradox revisited</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2005-08-01</date><risdate>2005</risdate><volume>150</volume><issue>2</issue><spage>358</spage><epage>364</epage><pages>358-364</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><coden>AHJOA2</coden><abstract>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.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>16086943</pmid><doi>10.1016/j.ahj.2004.01.032</doi><tpages>7</tpages></addata></record> |
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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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