Effect of Smoking on Outcomes of Primary PCI in Patients With STEMI.
J Am Coll Cardiol
; 75(15): 1743-1754, 2020 04 21.
Article
em En
| MEDLINE
| ID: mdl-32299585
ABSTRACT
BACKGROUND:
Smoking is a well-established risk factor for ST-segment elevation myocardial infarction (STEMI); however, once STEMI occurs, smoking has been associated with favorable short-term outcomes, an observation termed the "smoker's paradox." It has been postulated that smoking might exert protective effects that could reduce infarct size, a strong independent predictor of worse outcomes after STEMI.OBJECTIVES:
The purpose of this study was to determine the relationship among smoking, infarct size, microvascular obstruction (MVO), and adverse outcomes after STEMI.METHODS:
Individual patient-data were pooled from 10 randomized trials of patients with STEMI undergoing primary percutaneous coronary intervention. Infarct size was assessed at median 4 days by either cardiac magnetic resonance imaging or technetium-99m sestamibi single-photon emission computed tomography. Multivariable analysis was used to assess the relationship between smoking, infarct size, and the 1-year rates of death or heart failure (HF) hospitalization and reinfarction.RESULTS:
Among 2,564 patients with STEMI, 1,093 (42.6%) were recent smokers. Smokers were 10 years younger and had fewer comorbidities. Infarct size was similar in smokers and nonsmokers (adjusted difference 0.0%; 95% confidence interval [CI] -3.3% to 3.3%; p = 0.99). Nor was the extent of MVO different between smokers and nonsmokers. Smokers had lower crude 1-year rates of all-cause death (1.0% vs. 2.9%; p < 0.001) and death or HF hospitalization (3.3% vs. 5.1%; p = 0.009) with similar rates of reinfarction. After adjustment for age and other risk factors, smokers had a similar 1-year risk of death (adjusted hazard ratio [adjHR] 0.92; 95% CI 0.46 to 1.84) and higher risks of death or HF hospitalization (adjHR 1.49; 95% CI 1.09 to 2.02) as well as reinfarction (adjHR 1.97; 95% CI 1.17 to 3.33).CONCLUSIONS:
In the present large-scale individual patient-data pooled analysis, recent smoking was unrelated to infarct size or MVO, but was associated with a worse prognosis after primary PCI in STEMI. The smoker's paradox may be explained by the younger age and fewer cardiovascular risk factors in smokers compared with nonsmokers.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Fumar
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Intervenção Coronária Percutânea
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Infarto do Miocárdio com Supradesnível do Segmento ST
Tipo de estudo:
Clinical_trials
/
Prognostic_studies
/
Risk_factors_studies
/
Systematic_reviews
Limite:
Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
J Am Coll Cardiol
Ano de publicação:
2020
Tipo de documento:
Article
País de afiliação:
Suécia