Current Smoking and Prognosis After Acute ST-Segment Elevation Myocardial Infarction

Figure 1. Smoking and Myocardial Hemorrhage After Acute ST-Segment Elevation Myocardial Infarction Current smoker (A to D) and nonsmoker (E to H) who underwent primary percutaneous coronary intervention (PCI) for lateral ST-segment elevation myocardial infarction. Both had TIMI (Thrombolysis in Myocardial Infarction) flow grade 3 post-PCI. Antithrombotic therapies, including aspirin, clopidogrel, and unfractionated heparin, were similar for both patients. Magnetic resonance imaging (MRI) was performed 2 days and 6 months later. (A to D) Imaging from a 58-year-old male current smoker. Symptom-to-balloon time was 8.5 h. Angiography revealed a proximally occluded circumflex coronary artery (yellow arrow, A). Two days later, myocardial hemorrhage was revealed by T2* mapping (white arrow, C). Late gadolinium enhancement revealed transmural infarction of the lateral left ventricular (LV) wall (white arrows, D) associated with microvascular obstruction (MVO) (yellow arrow, D). Baseline infarct size was 32.3%, LV ejection fraction 55%, and LV end-diastolic volume indexed to body surface area (LVEDVi) 83.8 ml/m2. Six months later, infarct size was 31.2% and LVEDVi 84.8ml/m2, consistent with adverse…

Figure 2. Flow Diagram Consolidated Standards of Reporting Trials flow diagram of the study. CMR = cardiac magnetic resonance; MRI = magnetic resonance imaging; STEMI = ST-segment elevation myocardial infarction.

Figure 3. Smoking and Microvascular Pathology After ST-Segment Elevation Myocardial Infarction Schematic of the pathophysiology of cigarette smoking, infarct pathology, and prognosis post–acute ST-segment elevation myocardial infarction (STEMI). The results indicate that smoking is associated with accelerated vascular risk. Despite a typically successful outcome after primary percutaneous coronary intervention (PCI), microvascular pathology within the infarct zone (MVO [microvascular obstruction] and myocardial hemorrhage) is more likely, which increases the long-term risk. CAD = coronary artery disease; IMH = intramyocardial hemorrhage; MACE = major adverse cardiac events.