Smoker's Paradox in Patients With ST‐Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
Key result
Smoking was associated with significantly lower risk-adjusted in-hospital mortality compared with nonsmoking in patients undergoing primary PCI for STEMI (adjusted OR 0.60; 95% CI 0.58-0.62; P<0.001).
Why the study?
Does smoking status reduce in-hospital mortality in patients aged ≥18 years undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction?
Population
985,174 patients aged ≥18 years who underwent primary percutaneous coronary intervention for ST-segment…
Comparison
Smokers (current and former) vs Nonsmokers
Design
Cohort
Follow-up
in-hospital
Authors
Discussion
Loading...
Member takes
Implication
No practice change from this association; leaves open confounding or bias in the smoker's paradox.
Key Points
- To determine whether the 'smoker's paradox'—lower in-hospital mortality among smokers—persists in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.
- Analyzed records from the 2003–2012 National Inpatient Sample databases including 985,174 patients aged ≥18 years undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.
- Identified 438,954 smokers (current and former; 44.6%) and compared clinical characteristics with nonsmokers.
- Utilized multivariable logistic regression and age-stratified analyses to evaluate the association between smoking status and in-hospital mortality, length of stay, and complications.
- Smokers had significantly lower observed in-hospital mortality compared with nonsmokers (2.0% vs 5.9%; unadjusted OR 0.32, 95% CI 0.31–0.33, P<0.001).
- Lower in-hospital mortality in smokers remained significant after multivariable baseline risk adjustment (adjusted OR 0.60, 95% CI 0.58–0.62, P<0.001) and across age-stratified analyses.
- Smokers experienced shorter hospital stays (3.5 vs 4.5 days, P<0.001), lower rates of postprocedure hemorrhage (4.2% vs 6.1%; adjusted OR 0.81, 95% CI 0.80–0.83, P<0.001), and fewer in-hospital cardiac arrests (1.3% vs 2.1%; adjusted OR 0.78, 95% CI 0.76–0.81, P<0.001).
Study Design
Type
Cohort (n=985,174)
Multicenter
Yes
Structured PICO
Does smoking status reduce in-hospital mortality in patients aged ≥18 years undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction?
P
Population
985,174 patients aged ≥18 years undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.
E
Exposure
Smokers (current and former)
C
Comparator
Nonsmokers
O
Outcome
In-hospital mortalityhard clinical
Main Result
Odds Ratio: 0.6 (95% CI 0.58–0.62)
Absolute Event Rate: 2% vs 5.9%
p-value: p=<0.001
In patients undergoing primary PCI for STEMI, smokers paradoxically have lower risk-adjusted in-hospital mortality compared to nonsmokers.
Cite This Study
Gupta et al. (2016) conducted a cohort in ST-segment elevation myocardial infarction (n=985,174). Smoking vs. Nonsmokers was evaluated on In-hospital mortality (adjusted OR 0.60, 95% CI 0.58-0.62, p=<0.001). Smoking was associated with significantly lower risk-adjusted in-hospital mortality compared with nonsmoking in patients undergoing primary PCI for STEMI (adjusted OR 0.60; 95% CI 0.58-0.62; P<0.001).