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The enigma of the 'smoker's paradox': Results from a single-center registry of patients with STEMI undergoing primary percutaneous coronary intervention.
Paradossi, Umberto; De Caterina, Alberto Ranieri; Trimarchi, Giancarlo; Pizzino, Fausto; Bastiani, Luca; Dossi, Filippo; Raccis, Mario; Bianchi, Giacomo; Palmieri, Cataldo; de Gregorio, Cesare; Andò, Giuseppe; Berti, Sergio.
Afiliación
  • Paradossi U; Fondazione Toscana G. Monasterio, Ospedale del Cuore, 54100 Massa, Italy.
  • De Caterina AR; Fondazione Toscana G. Monasterio, Ospedale del Cuore, 54100 Massa, Italy.
  • Trimarchi G; Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy.
  • Pizzino F; Fondazione Toscana G. Monasterio, Ospedale del Cuore, 54100 Massa, Italy.
  • Bastiani L; Fondazione Toscana G. Monasterio, Ospedale del Cuore, 54100 Massa, Italy.
  • Dossi F; Department of Cardiology, Ospedale di Lavagna, 16033 Lavagna, Italy.
  • Raccis M; Department of Cardiology, Ospedale di Lavagna, 16033 Lavagna, Italy.
  • Bianchi G; Fondazione Toscana G. Monasterio, Ospedale del Cuore, 54100 Massa, Italy.
  • Palmieri C; Fondazione Toscana G. Monasterio, Ospedale del Cuore, 54100 Massa, Italy.
  • de Gregorio C; Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy.
  • Andò G; Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy. Electronic address: giuseppe.ando@unime.it.
  • Berti S; Fondazione Toscana G. Monasterio, Ospedale del Cuore, 54100 Massa, Italy.
Cardiovasc Revasc Med ; 2024 Jun 08.
Article en En | MEDLINE | ID: mdl-38862370
ABSTRACT

BACKGROUND:

Smoker's paradox usually refers to the observation of a favorable outcome of smoking patients in acute myocardial infarction.

METHODS:

From April 2006 to December 2018 a population of 2456 patients with ST segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI) were prospectively enrolled in the MATRIX registry. Ischemic time, clinical, demographics, angiographic data, and 1-year follow-up were collected.

RESULTS:

Among 2546 patients admitted with STEMI, 1007 (41 %) were current smokers. Smokers were 10 years younger and had lower crude in-hospital and 1-year mortality (1.5 % vs 6 %, p < 0.0001 and 5 % vs 11 %, p < 0.0001), shorter ischemic time (203 [147-299] vs 220 [154-334] minutes, p = 0.002) and shorter decision time (60 [30-135] vs 70 [36-170] minutes, p = 0.0063). Smoking habit [OR0.37(95 % CI0.18-0.75)-p < 0.01], younger age [OR 1.06 (95%CI1.04-1.09)-p < 0.001] and shorter ischemic time [OR1.01(95%CI1.01-1.02)-p < 0.05] were associated to lower in-hospital mortality. Only smoking habit [HR0.65(95 % CI 0.44-0.9)-p = 0.03] and younger age [HR1.08 (95%CI1.06-1.09)-p < 0.001] were also independently associated to lower all-cause death at 1-year follow-up. After propensity matching, age, cardiogenic shock and TIMI flow <3 were associated with in-hospital mortality, while smoking habit was still associated with reduced mortality. Smoking was also associated with reduced mortality at 1-year follow-up (HR 0.54, 95 % CI [0.37-0.78]; p < 0.001).

CONCLUSIONS:

Smoking patients show better outcome after PCI for STEMI at 1-year follow-up. Although "Smoking paradox" could be explained by younger age of patients, other factors may have a role in the explanation of the phenomenon.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Cardiovasc Revasc Med Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Cardiovasc Revasc Med Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Estados Unidos