Association of smoking with myocardial injury and clinical outcome in patients undergoing mechanical reperfusion for ST-elevation myocardial infarction
Key result
Smoking was not associated with improved myocardial salvage or a lower risk of MACE at 12 months after adjusting for baseline risk factors (HR 0.71; 95% CI 0.36-1.38; P=0.31).
Why the study?
Does smoking improve myocardial salvage, reduce myocardial damage, or improve clinical outcomes in STEMI patients undergoing PPCI?
Population
727 consecutive patients with ST-elevation myocardial infarction reperfused within 12 hours after symptom…
Comparison
Current smoking (admission smoking status) vs Non-smoking
Design
Cohort
Follow-up
12 months
Authors
Discussion
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Member takes
Implication
No association after adjustment cautions against invoking the smoker's paradox in STEMI; leaves open residual confounding in observational data.
Study Design
Type
Cohort (n=727)
Multicenter
Yes
Structured PICO
Does smoking improve myocardial salvage, reduce myocardial damage, or improve clinical outcomes in STEMI patients undergoing PPCI?
P
Population
727 consecutive STEMI patients reperfused within 12 hours after symptom onset, followed for 12 months.
E
Exposure
Current smoking (admission smoking status)
C
Comparator
Non-smoking
O
Outcome
Cardiac magnetic resonance (CMR)-determined myocardial salvage and damage (area at risk, infarct size, myocardial salvage index, microvascular obstruction, and intramyocardial haemorrhage) and Major adverse cardiac event (MACE) rates at 12 monthssurrogate
Main Result
Hazard Ratio: 0.71 (95% CI 0.36–1.38)
Absolute Event Rate: 3.8% vs 8.2%
p-value: p=0.31
Smoking is not associated with improved myocardial salvage or reduced irreversible damage in STEMI patients undergoing PPCI, and the apparent 'smoker's paradox' for clinical outcomes is explained by baseline risk differences.
Cite This Study
Reinstadler et al. (2016) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=727). Smoking vs. Non-smokers was evaluated on Major adverse cardiac event (MACE) at 12 months (HR 0.71, 95% CI 0.36-1.38, p=0.31). Smoking was not associated with improved myocardial salvage or a lower risk of MACE at 12 months after adjusting for baseline risk factors (HR 0.71; 95% CI 0.36-1.38; P=0.31).