Background Smokers treated with thrombolysis for acute ST elevation myocardial infarction (STEMI) have a higher frequency of reperfusion and lower in-hospital mortality when compared to non-smokers. We examined the effects of smoking status on angiographic outcome, in-hospital and 12-month mortality following primary percutaneous coronary intervention in patients presenting with STEMI.
Methods We examined the effect of smoking status on clinical and angiographic outcomes in 228 patients with STEMI undergoing primary percutaneous coronary intervention in South East Scotland over a 12-month-period.
Results The study population was predominantly male (66%) with a mean age of 61 years (range 29–93). Patients who smoked were younger than ex-smokers or non-smokers (57±12 vs 66±12 vs 65±15 years respectively, p<0.0001) and were less likely to have had prior coronary intervention (9% vs 13% vs 11% respectively, p<0.01). The prevalence of traditional risk factors, culprit vessel, pre-procedural Thrombolysis in Myocardial Infarction (TIMI) flow grade, pain to balloon times, glycoprotein IIb/IIIa inhibitor use and procedural success rates were similar for smokers, ex- and non-smokers. Procedural success was achieved in 98% of patients and mortality at 12 months was 7%. There were no differences in post-procedure TIMI flow grade, corrected TIMI frame count, the proportion of patients with TIMI III flow in the infarct related artery, in-hospital or 12-month mortality between smokers, ex- and non-smokers.
|In-hospital mortality, n (%)||9 (3.9%)||4 (3.3%)||2 (3.7%)||3 (5.6%)||0.78|
|12-month mortality, n (%)||16 (7.0%)||9 (7.4%)||3 (5.6%)||4 (7.3%)||0.90|
|Procedural success, n (%)||223 (98%)||118 (98%)||51 (94%)||54 (100%)||0.12|
|End-procedure TIMI flow grade*||2.8±0.6||2.8±0.5||2.8±0.7||2.9±0.3||0.19|
|End-procedure TIMI III flow*, n (%)||206 (90%)||108 (90%)||48 (89%)||50 (93%)||0.79|
|End-procedure corrected TIMI frame count*||11±5||11±5||11±5||11±6||0.97|
↵* TIMI data from infarct-related artery. Figures are presented as mean±SD unless otherwise stated.
Conclusions In patients presenting with STEMI, primary percutaneous coronary intervention is associated with high rates of reperfusion in the infarct-related artery and low 12-month mortality, irrespective of smoking status. The “smokers paradox” observed with thrombolytic therapy does not extend to patients treated with primary percutaneous coronary intervention for STEMI. These findings provide support for the hypothesis that the smokers paradox can be explained by a defect in endogenous fibrinolytic activity induced by smoking.
- primary percutaneous coronary intervention
- acute myocardial infarction
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