title: Impact of smoking on outcomes of patients with ST-segment elevation myocardial infarction (from the HORIZONS-AMI Trial).
abstract: We assessed the impact of smoking on outcomes in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention using alternative antithrombotic regimens and stent types. In the HORIZONS-AMI trial 3,602 patients were randomly assigned to unfractionated heparin (UFH) plus a glycoprotein IIb/IIIa inhibitor (GPI) or bivalirudin alone and paclitaxel-eluting stents or bare-metal stents. Compared to nonsmokers, smokers had significantly lower rates of mortality and major bleeding at 30 days and at 1 year; however, the differences were no longer significant after covariate adjustment. Smoking was associated with increased rates of definite/probable stent thrombosis (ST) at 1 year (adjusted RR 1.99, 95% confidence interval 1.28 to 3.10) mainly because of a higher rate of late ST after paclitaxel-eluting stent implantation (1.9% vs 0.4%, p = 0.0006). In smokers bivalirudin monotherapy compared to UFH plus a GPI was associated with lower mortality at 30 days (0.5% vs 2.2%, p = 0.002) and at 1 year (1.8% vs 4.0%, p = 0.008). No decrease in mortality was seen with bivalirudin in nonsmokers. Major bleeding was significantly decreased with bivalirudin regardless of smoking status (smokers 3.7% vs 8.9%, p <0.0001; nonsmokers 6.5% vs 9.6%, p = 0.01). In conclusion, in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention, smoking is an independent predictor of definite/probable ST at 1 year. Bivalirudin monotherapy compared to UFH plus a GPI decreased major bleeding regardless of smoking status but may have different effects on individual components of ischemic events.
authors.affiliation: Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York, USA.
authors.forename: Kenji
authors.initials: K
authors.lastname: Goto
authors.forename: Eugenia
authors.initials: E
authors.lastname: Nikolsky
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: George
authors.initials: G
authors.lastname: Dangas
authors.forename: Bernhard
authors.initials: B
authors.lastname: Witzenbichler
authors.forename: Helen
authors.initials: H
authors.lastname: Parise
authors.forename: Giulio
authors.initials: G
authors.lastname: Guagliumi
authors.forename: Ran
authors.initials: R
authors.lastname: Kornowski
authors.forename: Bimmer E
authors.initials: BE
authors.lastname: Claessen
authors.forename: Martin
authors.initials: M
authors.lastname: Fahy
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000991:Antithrombins / Q000627:therapeutic use; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000453:epidemiology; D003328:Coronary Thrombosis / Q000453:epidemiology*; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology; D006493:Heparin / Q000627:therapeutic use; D006629:Hirudins; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D017239:Paclitaxel / Q000008:administration & dosage; D010446:Peptide Fragments / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011725:Pyridines / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000627:therapeutic use; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*; D015607:Stents / Q000009:adverse effects*
chemical_list: D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011725:Pyridines; D011994:Recombinant Proteins; C446540:thienopyridine; D006493:Heparin; D017239:Paclitaxel; C074619:bivalirudin