Sport-related acute myocardial and tobacco smoking; findings from a regional prospective registry

Background Cigarette consumption is a major cardiovascular (CV) risk factor, especially when smoking just before or during exercise. Only few data are available on smoking in sport-related myocardial infarction (SR-MI). Methods We analysed characteristics of the smokers of IMACS, a regional prospective multicentre cohort including all patients hospitalised for a SR-MI. SR-MI was defined as MI onset occurring during sport or within the 1st hour of recovery. A one-year follow-up was performed by phone call. Results From April 1st 2018 to October 17th 2023, 151 SRMI were included, of whom 13 (8.6%) were female, median age was 61-y. and 39 (25.8%) were current smokers, of whom only 1 was woman (Table). Cycling was the most frequent sport (33.8%) followed by fitness (11.9%), jogging (11.3%) and hiking (10.6%). (Figure). When compared with non-smokers, smokers were 6.5 -y younger (P = 0.001). However, the rate of CV risk factor, STEMI, CV history and prodromal symptoms before the sport session were similar whatever smoking status. Among smokers, 26 (66.7%) declared cigarette consumption within the 2 hours before the sport session or the event. Out of hospital cardiac arrest (OHCA) occurred in 19 (12.6%) patients, more commonly among patients with prior coronary artery disease (CAD) (p = 0.04). OHCA was more common among smokers (p = 0.04); 8 of them (88.9%) had smoked within the 2 hours before the sport session or the event. At follow-up, only one patient suddenly died 8 days after discharge and another one benefitted from cardioversion delivered by its implanted automatic defibrillator (while doing do-it-yourself). Among the survivors at one year follow-up (131 patients, no patient lost in follow up), 97 benefitted from a rehabilitation program and 30 from the 34 smokers quitted. Among the quitters, 5 switched to electronic cigarette. Conclusions Although smoking is at high CV risk, especially in the setting of sport, the rate of smokers remains high (> 25%) in patients hospitalised for SR-MI. Moreover, almost two-third had smoked just before the event and appeared associated with occurrence of OCHA. These data highlight the need for prevention programs aiming to reduce the risk of tobacco, especially in sport setting.