Primary or rescue percutaneous coronary intervention in smokers

Background Despite the close association between smoking and atherosclerotic disease development, little is known about the clinical characteristics and outcomes related to percutaneous coronary intervention (PCI) in smokers with acute coronary syndrome in Brazil. This study aimed to analyze the clinical, angiographic, and procedural profile, in addition to in-hospital outcomes, in smokers and non-smokers with acute myocardial infarction with ST-segment elevation (STEMI) submitted to primary or rescue PCI. Methods Cross-sectional study of the Central Nacional de Intervenções Cardiovasculares (CENIC) registry between 2006 and 2016. The study population included patients aged ≥ 18 years who presented with STEMI and were submitted to primary or rescue PCI. Results A total of 20,319 patients were included, of whom 6,880 (34.4%) were smokers. The group of smokers was significantly younger, male, and with a lower prevalence of comorbidities. At angiography, smokers showed greater complexity, with a higher prevalence of thrombi, long lesions or TIMI flow 0/1. During the procedure, smokers received a lower proportion of drug-eluting stents and thrombus aspiration was more frequent, as well as procedural success (94.2% vs. 92.1%; p < 0.0001). In the univariate analysis, smokers showed lower mortality (2.9% vs. 4.5%; p < 0.0001) and fewer major adverse cardiac events (3.3% vs. 4.8%; p < 0.0001). However, after multivariate analysis, smoking was not associated with a lower risk of mortality. Conclusions Although the clinical outcomes associated with the PCI were favorable to smokers, the multivariate analysis did not show a protective effect of smoking. Such results are due to differences in clinical and angiographic characteristics between smokers and non-smokers.