title: Long-term prognostic factors of young patients (<or=35 years) having acute myocardial infarction: the detrimental role of continuation of smoking.
abstract: BACKGROUND
  There are few and conflicting data regarding the prognostic role of continued smoking in very young survivors of acute myocardial infraction (AMI) after the event.
  
  
  METHODS
  We conducted a prospective study to evaluate the impact of smoking habits on long-term outcome in individuals who sustained AMI at the age of <or=35 years.
  
  
  METHODS
  We recruited 147 consecutive patients who had survived their first AMI at the age of <or=35 years. Patients were followed up for up to 10 years. Clinical end points were: readmission for acute coronary syndrome, cardiac death or coronary revascularization because of clinical deterioration.
  
  
  RESULTS
  The most prevalent risk factor at presentation was smoking (94.8%). Follow-up data were obtained by 135 patients (32+/-3 years old, 115 men). During follow-up 75 (55.6%) patients reported continuation of smoking. Forty-four (32.6%) patients presented cardiac events (three cardiac deaths, 30 acute coronary syndromes, and 11 revascularizations). Multivariable data analysis showed that persistence of smoking (relative risk=2.35, 95% confidence interval 1.5-5.25, P=0.03) and ejection fraction at presentation (relative risk=0.95, 95% confidence interval 0.91-0.98, P=0.008) were the only significant predictors of cardiac events after adjusting for various confounding factors. In addition, continuation of smoking was the most significant predictor of cardiac events during follow-up in our sample (i.e. had the lowest log-likelihood ratio as compared with ejection fraction or other covariates).
  
  
  CONCLUSIONS
  Persistence of smoking is the most powerful predictor for the recurrence of cardiac events in patients with premature AMI.
authors.affiliation: Second Department of Cardiology, University General Hospital, 'Attikon', Greece. rallidis@ath.forthnet.gr
authors.forename: Loukianos S
authors.initials: LS
authors.lastname: Rallidis
authors.forename: John
authors.initials: J
authors.lastname: Lekakis
authors.forename: Demosthenes
authors.initials: D
authors.lastname: Panagiotakos
authors.forename: Katerina
authors.initials: K
authors.lastname: Fountoulaki
authors.forename: Christoforos
authors.initials: C
authors.lastname: Komporozos
authors.forename: Thomas
authors.initials: T
authors.lastname: Apostolou
authors.forename: Ioannis
authors.initials: I
authors.lastname: Rizos
authors.forename: Dimitrios T
authors.initials: DT
authors.lastname: Kremastinos