title: [Revision of the "Smoker's Paradox": smoking is not a good prognostic factor immediately after myocardial infarction].
abstract: In order to determine the reasons for the low mortality after myocardial infarction in smokers compared with non-smokers (the smoker's paradox), the authors analysed the initial clinical data, the therapeutic interventions and hospital mortality in 790 consecutive patients (555 smokers, 235 non-smokers) admitted to hospital within 6 hours of the first symptoms of acute myocardial infarction and treated by intravenous thrombolytic agents and/or coronary angioplasty. Multivariate analysis with linear regression was used to identify the predictive factors of hospital mortality. The main differences between smokers and non-smokers were age (56 vs 67 years, p < 0.0001), gender (male, 90 vs 60%, p < 0.01), cardiogenic shock on admission (3 vs 8%, p < 0.01). TIMI 3 flow was obtained in the culprit artery in 84% of smokers and 79% of non-smokers (NS). Hospital mortality was 5% in the smoking population and 16% in non-smokers (p < 0.0001). In multivariate analysis, the variables of cardiogenic shock, age, gender and hypertension provided most of the prognostic information and tobacco consumption did not appear to have a protective effect. In patients admitted to hospital with acute myocardial infarction, identical incidences of early reperfusion are obtained in smokers and in non-smokers. However, mortality is higher in the non-smoking group due to more severe clinical characteristics on admission. Tobacco consumption is not a protective factor in the immediate period after acute myocardial infarction.
authors.affiliation: Services de cardiologie A et B, hôpital Bichat-Claude-Bernard, 46, rue Henri Huchard, 75018 Paris.
authors.forename: D
authors.initials: D
authors.lastname: Himbert
authors.forename: J M
authors.initials: JM
authors.lastname: Juliard
authors.forename: J L
authors.initials: JL
authors.lastname: Golmard
authors.forename: L J
authors.initials: LJ
authors.lastname: Feldman
authors.forename: P
authors.initials: P
authors.lastname: Aubry
authors.forename: H
authors.initials: H
authors.lastname: Benamer
authors.forename: D
authors.initials: D
authors.lastname: Karila-Cohen
authors.forename: L
authors.initials: L
authors.lastname: Gauci
authors.forename: P G
authors.initials: PG
authors.lastname: Steg
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000473:pathology; D011379:Prognosis; D012044:Regression Analysis; D015427:Reperfusion Injury / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic; D012907:Smoking / Q000009:adverse effects*