title: Implications of cigarette smoking for the management of patients with acute coronary syndromes.
abstract: Smokers differ from nonsmokers in the way they present with acute coronary syndromes and in how they respond to treatment. Although smoking increases the risk of a coronary event and accelerates the progression of established atherosclerosis, paradoxically, smokers have better short-term survival after an acute myocardial infarction, mainly because they are younger and have more favorable coronary anatomy. Thrombolysis appears to be a better treatment in smokers than in nonsmokers, probably because thrombosis plays a more important role in the pathogenesis of acute coronary events in smokers. Patients who continue to smoke after angioplasty or bypass surgery have a worse outcome than nonsmokers or quitters. The 2.5- to 3-fold increase in risk for myocardial infarction or stroke in smokers compared with nonsmokers decreases exponentially after smoking cessation. By 4 years the risk is only slightly higher than the risk of a subject who never smoked.
authors.affiliation: Division of Cardiology, San Francisco General Hospital and the University of California, San Francisco School of Medicine, San Francisco, CA 94110, USA.
authors.forename: Louise
authors.initials: L
authors.lastname: Metz
authors.forename: David D
authors.initials: DD
authors.lastname: Waters
mesh_terms: D002986:Clinical Trials as Topic; D006801:Humans; D009203:Myocardial Infarction / Q000503:physiopathology* / Q000628:therapy*; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012907:Smoking / Q000503:physiopathology*