title: 'Smoker's paradox' in young patients with acute myocardial infarction.
abstract: 1. Of the patients suffering from acute myocardial infarction (AMI), smokers are younger than non-smokers, which may be a major confounding factor causing 'smoker's paradox'. Therefore, in the present study we evaluated the 'smoker's paradox' in young patients with AMI.2. In all, 1218 young AMI patients (≤ 45 years of age), comprising 990 smokers and 228 non-smokers, were enrolled in the present study. In-hospital and 8 months clinical outcomes were compared between the smokers and non-smokers. 3. Baseline clinical characteristics showed that smokers were more likely to be male (97.9% vs 72.4%; P < 0.001) and had a higher rate of ST-segment elevation myocardial infarction (71.3% vs 59.5%; P = 0.001) than non-smokers. Clinical outcomes showed that smokers had lower rates of in-hospital cardiac death (0.8% vs 3.5%; P = 0.004), total death (0.8% vs 3.5%; P = 0.004) and 8 months cardiac death (1.1% vs 3.9%; P = 0.006) and total death (1.3% vs 4.4%; P = 0.005) than non-smokers. Multivariable logistic analysis showed that current smoking was an independent protective predictor of 8 months cardiac death (odds ratio (OR) 0.25; 95% confidence interval (CI) 0.07-0.92; P = 0.037) and total death (OR 0.26; 95% CI 0.09-0.82; P = 0.021). Subgroup analysis in patients who underwent percutaneous coronary intervention after AMI showed that current smoking was an independent protective predictor of 8 months total major adverse cardiac events (OR 0.47; 95% CI 0.23-0.97; P = 0.041). 4. Current smoking seems to be associated with better clinical outcomes in young patients with AMI, suggesting the existence of the 'smoker's paradox' in this particular subset of patients.
authors.affiliation: Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.
authors.forename: Kang-Yin
authors.initials: KY
authors.lastname: Chen
authors.forename: Seung-Woon
authors.initials: SW
authors.lastname: Rha
authors.forename: Yong-Jian
authors.initials: YJ
authors.lastname: Li
authors.forename: Zhe
authors.initials: Z
authors.lastname: Jin
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Minami
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Park
authors.forename: Kanhaiya L
authors.initials: KL
authors.lastname: Poddar
authors.forename: Sureshkumar
authors.initials: S
authors.lastname: Ramasamy
authors.forename: Lin
authors.initials: L
authors.lastname: Wang
authors.forename: Guang-Ping
authors.initials: GP
authors.lastname: Li
authors.forename: Cheol-Ung
authors.initials: CU
authors.lastname: Choi
authors.forename: Dong Joo
authors.initials: DJ
authors.lastname: Oh
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
mesh_terms: D000328:Adult; D002423:Cause of Death; D002986:Clinical Trials as Topic; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000601:surgery; D011379:Prognosis; D012907:Smoking / Q000453:epidemiology*; D016896:Treatment Outcome