title: Non-smokers are more prone to pulmonary oedema than smokers during acute coronary syndrome.
abstract: OBJECTIVE
  Acute coronary syndrome (ACS) patients are prone to develop pulmonary oedema with varied degree of hypoxaemia. The aim was to compare the risk for pulmonary oedema and related complications during ACS amongst non-smokers vs. smokers.
  
  
  METHODS
  Prospective, observational study was performed in consecutive 68 patients presenting with ACS. They were divided into two groups; group 1 (n = 33) non-smokers and group 2 (n = 35) chronic smokers. Standard conservative treatment was given to maintain mean arterial pressure >or= 60 mmHg, oxygen saturation > 95%. The bedside chest x-ray was graded for Battler grading (0-4) for pulmonary oedema. All patients were evaluated for troponin, serial creatinine kinase, echocardiography, arterial blood gas, renal function and correlated with inotropes requirement, active respiratory support, coronary care unit (CCU) stay and hospital outcome.
  
  
  RESULTS
  Patients in both the groups had similar cardiac involvement for cardiothoracic ratio, troponin, ejection fraction and creatinine kinase muscle and brain (CK-MB). The bedside chest x-ray revealed significant (p < 0.05) lung oedema grades (3 and 4) in 60% non-smokers (group 1) vs. smokers (11%). These patients (group 1) also presented with significant (p < 0.001) hypoxaemia (lower PaO(2)/FiO(2)-201 +/- 44), metabolic acidosis (higher lactate; 2.1 +/- 0.72 mmol/l, base deficit; -5.1 +/- 4.8) and hypocarbia (28 +/- 2.9 mmHg) than smokers (group 2). The risk estimates for active respiratory support (OR =1.716) and inotrope use (OR = 1.836) was three times higher in non-smokers than smokers.
  
  
  CONCLUSIONS
  The higher degree of pulmonary oedema and hypoxemia probably contributed to poor short-term outcome in non-smokers than smokers. It would be important to recognise and treat hypoxaemia in non-smokers during ACS.
authors.affiliation: Department of Anaesthesiology and Critical Care, BP Koirala Institute of Health Sciences, Dharan, Nepal. mukesh_tripathi@yahoo.com
authors.forename: M
authors.initials: M
authors.lastname: Tripathi
authors.forename: M
authors.initials: M
authors.lastname: Pandey
authors.forename: U
authors.initials: U
authors.lastname: Singh
authors.forename: S
authors.initials: S
authors.lastname: Dwivedi
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000150:complications*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood / Q000627:therapeutic use; D010102:Oxygen Inhalation Therapy; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000097:blood / Q000209:etiology*; D018570:Risk Assessment; D012907:Smoking / Q000009:adverse effects* / Q000097:blood
chemical_list: D010100:Oxygen