Key result
Current smoking is not associated with in-hospital mortality in patients presenting with ACS.
Why the study?
The impact of cigarette smoking on short-term, in-hospital outcomes among patients presenting with acute coronary syndrome remains controversial with conflicting evidence and debate about the smoker's paradox.
Does current smoking status impact short-term in-hospital clinical outcomes in adult patients presenting with acute coronary syndrome?
Observational (n=157)
No
Does current smoking status impact short-term in-hospital clinical outcomes in adult patients presenting with acute coronary syndrome?
Absolute Event Rate: 12.9% vs 9.7%
p-value: p=>0.05
Smoking status does not appear to significantly alter short-term, in-hospital clinical outcomes in patients presenting with acute coronary syndrome, arguing against the concept of a 'smoker's paradox'.
Should not yet alter acute ACS risk assessment by smoking status; leaves open the smoker's paradox debate pending prospective validation.
Background: Cigarette smoking is a well-established modifiable risk factor for the development of acute coronary syndrome (ACS). However, its impact on short-term, in-hospital outcomes among patients presenting with ACS remains controversial, with conflicting evidence and the ongoing debate surrounding the so-called “smoker’s paradox.” This study aimed to compare in-hospital clinical outcomes between smoker and non-smoker patients presenting with acute coronary syndrome. Methods: This prospective, hospital-based observational comparative study was conducted in the Department of Cardiology, Khyber Teaching Hospital, Peshawar, Pakistan, over a six-month period. Adult patients (≥18 years) presenting with confirmed ACS, including ST-segment elevation myocardial infarction, non–ST-segment elevation myocardial infarction, or unstable angina, were consecutively enrolled. Patients were categorized as smokers or non-smokers based on predefined criteria at admission. Baseline demographic characteristics, cardiovascular risk factors, clinical presentation, and in-hospital management were recorded. In-hospital outcomes, including acute heart failure, cardiogenic shock, arrhythmias, stroke, in-hospital mortality, and length of hospital stay, were compared between the two groups using appropriate statistical tests. Results: A total of 157 patients were included, comprising 85 smokers (54.1%) and 72 non-smokers (45.9%). Baseline characteristics, including age, body mass index, cardiovascular risk factors, ACS type, Killip class, and in-hospital management strategies, were comparable between the two groups. No statistically significant differences were observed between smokers and non-smokers with respect to acute heart failure, cardiogenic shock, arrhythmias, stroke, in-hospital mortality, or length of hospital stay. Conclusion: In this cohort of patients presenting with acute coronary syndrome, smoking status was not associated with differences in short-term, in-hospital clinical outcomes or duration of hospitalization. These findings underscore the importance of distinguishing short-term hospital outcomes from the well-established long-term cardiovascular risks associated with smoking. Despite comparable in-hospital prognosis, smoking cessation remains a critical component of secondary prevention in patients with acute coronary syndrome.
No takes yet. Share an insight, caveat, or question.
Khan et al. (2026) conducted an observational in Acute Coronary Syndrome (n=157). Current smoking vs. Non-smokers (including never-smokers and former smokers) was evaluated on In-hospital mortality (p=>0.05). In patients presenting with acute coronary syndrome, current smoking was not associated with statistically significant differences in in-hospital mortality (12.9% vs 9.7%, p>0.05) or other short-term outcomes compared to non-smokers.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: