["Smoker's paradox" and reperfusion's strategy in acute myocardial infarction].
Previous studies have shown that smokers with acute myocardial infarction (AMI) treated by thrombolysis have lower mortality rates than nonsmokers, a phenomenon often termed "smoker's paradox". This "smoker's paradox" has been rarely studied in case of primary angioplasty.


OBJECTIVE
To evaluate the impact of smoking status on the early mortality of patients admitted with AMI with regard to the strategy of reperfusion (intravenous thrombolysis versus primary angioplasty).


METHODS
Study undertaken from the Monsatir registry of ST elevation MI including 688 patients having had either a hospital or a prehospital thrombolysis (n=397) or a primary angioplasty (n=291). Among those patients, 482 (70.1%) were active smokers.


RESULTS
In the thrombolysis group, the prevalence of hypertension, diabetes and anterior location of MI was significantly less among smokers. In the group primary angioplasty, only diabetes and hypertension were less frequent. The immediate mortality was significantly less among smokers in case of thrombolysis comparatively to non-smokers (5.3 vs 13%; p=0.008). By multivariate analysis, cardiogenic shock (p<0.0001), anterior MI (p=0.03) and active smoking (p=0.03) were independent predictive factors of mortality in case of thrombolysis. A trend toward a lower mortality among smokers was observed in the primary angioplasty group (10 vs 17.6%; p=0.07).


CONCLUSIONS
"The smoker's paradox" seems to be observed mainly among patients having had thrombolysis.
Addad
F
F
Unité de recherche cardiothrombose 04-08, service de cardiologie A, CHU Fattouma Bourguiba, 5000 Monastir, Tunisie. faouzi.addad@rns.tn
Dridi
Z
Z
Jemmali
M
M
Mzoughi
K
K
Hassine
M
M
Ghrissi
I
I
Hamdi
S
S
Mahjoub
M
M
Betbout
F
F
Ben Farhat
M
M
Gamra
H
H
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods* / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000401:mortality; D012907:Smoking / Q000009:adverse effects / Q000401:mortality; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D014416:Tunisia / Q000453:epidemiology
D000925:Anticoagulants; D005343:Fibrinolytic Agents