Clinical InvestigationImpact of smoking status on outcomes of primary coronary intervention for acute myocardial infarction—The smoker's paradox revisited
Section snippets
Study population and protocol
The CADILLAC study protocol has been described in detail elsewhere.14 Briefly, 2082 patients >18 years of age with the presence of >30 minutes but <12 hours of symptoms consistent with AMI, and ST-segment elevation in ≥2 contiguous leads or left bundle-branch were enrolled. Patients with other electrocardiographic patterns were also eligible if angiography demonstrated a high-grade stenosis and associated regional wall motion abnormalities. Major exclusion criteria included cardiogenic shock;
Results
Of the 2082 patients randomized in CADILLAC, 638 (31%) never smoked, 898 (43%) were current smokers, and 546 (26%) quit smoking at least 1 month before the AMI.
Discussion
In this analysis from the CADILLAC trial, the largest prospective study to date of mechanical reperfusion strategies in patients with AMI, current smokers had greater survival compared to nonsmokers or former smokers, both at 30 days and at 1 year of follow-up. In addition, rates of reinfarction were lower in current smokers during the 1-year follow-up period, resulting in lower composite rates of major adverse cardiac events in cigarette users. Indeed, a “dose-response” curve was evident, with
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