title: Impact of smoking on acute phase outcomes of myocardial infarction.
abstract: OBJECTIVE
  Previous studies have found an apparent paradox in smokers: acute phase outcomes after an acute myocardial infarction are superior to those of nonsmokers. Furthermore, it is reported that smoking has an impact on the metabolism of clopidogrel. This study aimed to examine whether this paradoxical finding exists in patients who undergo drug-eluting stent implantation and are treated with clopidogrel.
  
  
  METHODS
  From April 2003 to June 2010, 1424 consecutive patients with acute myocardial infarction who underwent primary or rescue percutaneous coronary intervention with drug-eluting stent and clopidogrel were enrolled. They were divided into three groups: current smokers (n = 486); previous smokers (n = 349); and nonsmokers (n = 589). The primary end point was a composite of 30-day, all-cause death, nonfatal myocardial infarction, or definite stent thrombosis.
  
  
  RESULTS
  Compared with nonsmokers, current smokers were younger (P < 0.001) and more often men (P < 0.001). They had larger myocardial infarctions than did nonsmokers [maximum troponin I, 8.9 (2.4, 38.4) vs. 6.8 (1.4, 30.1) ng/ml, P = 0.01]. Current smokers less frequently met the primary end point than did nonsmokers (2.9 vs. 6.1%, P = 0.01). However, after adjustment for baseline and angiographic characteristics, the beneficial effect of smoking was no longer seen (odds ratio 1.35, confidence interval: 0.53-3.44, P = 0.5).
  
  
  CONCLUSIONS
  A beneficial effect of smoking ('smoker's paradox') in the unadjusted primary end point continues to be present; however, after adjustment for differences in baseline characteristics, no benefit was detectable.
authors.affiliation: Division of Cardiology, Cardiovascular Research Institute, Washington Hospital Center, Washington, DC, USA.
authors.forename: Kohei
authors.initials: K
authors.lastname: Wakabayashi
authors.forename: Rafael
authors.initials: R
authors.lastname: Romaguera
authors.forename: Ana
authors.initials: A
authors.lastname: Laynez-Carnicero
authors.forename: Gabriel
authors.initials: G
authors.lastname: Maluenda
authors.forename: Itsik
authors.initials: I
authors.lastname: Ben-Dor
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sardi
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gaglia
authors.forename: Michael
authors.initials: M
authors.lastname: Mahmoudi
authors.forename: Manuel A
authors.initials: MA
authors.lastname: Gonzalez
authors.forename: Cedric
authors.initials: C
authors.lastname: Delhaye
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.forename: Zhenyi
authors.initials: Z
authors.lastname: Xue
authors.forename: William O
authors.initials: WO
authors.lastname: Suddath
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Kent
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.forename: Joseph
authors.initials: J
authors.lastname: Lindsay
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000208:Acute Disease; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000077144:Clopidogrel; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology* / Q000628:therapy; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D012042:Registries; D012907:Smoking / Q000503:physiopathology*; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine