Key result
Smoking in young ACS links to STEMI and multi-vessel disease with no in-hospital mortality difference.
Why the study?
To determine the frequency of smoking and smokeless tobacco use and its impact on in-hospital MACE among patients under 45 years of age presenting with ACS.
Does smoking or smokeless tobacco use impact in-hospital outcomes and disease presentation in ACS patients under 45 years of age?
Cross-Sectional (n=172)
No
Does smoking or smokeless tobacco use impact in-hospital outcomes and disease presentation in ACS patients under 45 years of age?
Absolute Event Rate: 2.9% vs 0%
In young ACS patients, smoking is associated with STEMI and multi-vessel disease, whereas smokeless tobacco use is associated with unstable angina and single-vessel disease, though in-hospital mortality does not differ.
Supports distinct ACS presentations by tobacco type in young adults; hypothesis-generating and should not yet change practice.
Objective: This study has been designed to determine frequency of smoking and smokeless tobacco and its impact on in-hospital MACE among acute coronary syndrome patients of age less than 45 years managed at public sector hospital in Karachi, Pakistan. Methodology: This cross-sectional study was performed in Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi from 1st January 2024 to 30th July 2024. Patients of both the gender of age at least 18-45 years and presenting with ACS were studied. Patients were followed till their discharge or in-hospital mortality to record final outcome. Results: Total 172 patients were studied with mean age of 40.5 ± 4.8 years. Majority of participants were males (89%). Most of the patients were smokers (39.5%) while some were consuming smokeless tobacco (12.2%) and few were using both (3.5%). Smoking was higher in males (100% versus 0%) whereas smokeless tobacco consumption was higher in females (38.1% versus 61.9%). Among smokers, STEMI (60.3%) was more prevalent followed by nSTEMI (23.5%) and unstable angina (16.2%). In smokeless tobacco users, unstable angina (61.9%) was more common followed by nSTEMI (28.6%) and STEMI (9.5%). Multiple level disease was more common in smokers (66.2%) while among smokeless tobacco users single level was common (66.7%). Education and comorbidity was significantly different. Conclusion: The present study found that STEMI and multi-level vessel disease was common in smokers whereas in consumers of smokeless tobacco, unstable angina and single-level disease was frequent. No differences were found in terms of mortality among smokers, consumers of smokeless tobacco and those who were not smoking.
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Khan et al. (2025) conducted a cross-sectional in Acute Coronary Syndrome (n=172). Smoking and smokeless tobacco vs. No tobacco use was evaluated on In-hospital mortality. Among young patients with acute coronary syndrome, STEMI and multi-vessel disease were more common in smokers, while unstable angina and single-vessel disease were frequent in smokeless tobacco users, with no significant difference in in-hospital mortality.
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