Key result
Current smoking was not associated with 1-year mortality compared with never smoking in patients with acute STEMI treated with primary PCI (HR 1.47; 95% CI 0.90-2.39; p=0.23).
Why the study?
Does smoking status affect 1-year mortality in patients with acute STEMI managed by primary PCI?
Cohort (n=1,796)
No
Does smoking status affect 1-year mortality in patients with acute STEMI managed by primary PCI?
In patients with STEMI undergoing primary PCI, smoking status was not significantly associated with 1-year mortality after adjusting for age and other risk factors, challenging the existence of a 'smoker's paradox'.
Answers are grounded in this paper and cite their sources.
Smoking status should not alter prognosis or risk stratification after primary PCI for STEMI; this cohort study leaves open whether a smoker's paradox exists after adjustment.
BACKGROUND: Several studies have shown a 'smoker's paradox', where following an acute myocardial infarction, smokers have a paradoxically lower mortality than non-smokers. To date, no large study has investigated this paradox in unselected patients with acute ST-segment elevation myocardial infarction (STEMI) managed by primary percutaneous coronary intervention (PCI) alone. OBJECTIVES: We aimed to examine the association of smoking status and 1-year mortality in patients who had STEMI managed by primary PCI. METHODS: This retrospective study included all patients admitted with acute STEMI undergoing primary PCI in a single UK centre from January 2009 to April 2012. The survival status for all patients post-STEMI was obtained. Differences in survival by smoking status were assessed using a Kaplan-Meier curve, and after adjustment for age, gender and additional cardiovascular risk factors using a Cox regression analysis. RESULTS: The 1-year mortality for patients with STEMI was 149/1796 (8.3%). There were 846/1796 (47.1%) current smokers, 476/1796 (26.5%) ex-smokers and 417/1796 (23.2%) never smokers. Current smokers were approximately 10 years younger than ex-smokers and never smokers (p=0.001). A multivariate Cox proportional hazards model found no evidence of an association between mortality and smoking status after adjustment; p=0.23. Compared with never smokers, the HR (95% CI) for 1-year mortality for current smokers was 1.47 (0.90 to 2.39) and 1.08 (0.66 to 1.77) for ex-smokers. CONCLUSIONS: In this retrospective cohort study, we found no evidence of an association between mortality and smoking status in patients with acute STEMI treated with PCI, and thus no evidence of a 'smoker's paradox'.
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Steele et al. (2017) conducted a cohort in Acute ST-segment elevation myocardial infarction (STEMI) (n=1,796). Current smoking vs. Never smoking was evaluated on 1-year mortality (HR 1.47, 95% CI 0.90 to 2.39, p=0.23). Current smoking was not associated with 1-year mortality compared with never smoking in patients with acute STEMI treated with primary PCI (HR 1.47; 95% CI 0.90-2.39; p=0.23).
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