Tobacco modalities used and outcome in patients with acute coronary syndrome: an observational report.
OBJECTIVE
The authors evaluated the prevalence and effect of the various tobacco use modalities among patients presenting with acute coronary syndrome (ACS) and compared them with non-tobacco and ex-tobacco users.


METHODS
An analysis of the 2nd Gulf Registry of Acute Coronary Events conducted between October 2008 and June 2009 and which included 7930 consecutive patients hospitalised with ACS was made. Patients initially were divided into non-tobacco users, ex-tobacco users and current tobacco users. Subanalysis according to the tobacco modality used was subsequently made: cigarette, waterpipe or smokeless tobacco users.


RESULTS
Overall, 2834 (36%) patients were current tobacco users, 306 (3.9%) patients were waterpipe smokers and 240 patients (3%) were oral tobacco users. When compared with non-tobacco and ex-tobacco users, overall current tobacco users were younger, more likely to be male subjects and less likely to have diabetes mellitus, hypertension and dyslipidaemia. Mortality rate (p=0.001) and overall cardiovascular events (p=0.001) were lower among current tobacco users when compared with the other two groups. After adjustment for baseline variables, tobacco use was not an independent predictor of adverse events. Subset analysis demonstrates oral tobacco users and waterpipe smokers were older and more likely to be women when compared with cigarette smokers. Among the various tobacco groups, inhospital mortality rates were significantly higher among the waterpipe smokers when compared with the other two groups.


CONCLUSIONS
Clinical characteristics and outcomes of ACS patients depend on the tobacco modality used. Further studies are required to evaluate the impact of emerging tobacco use modalities on patients with coronary artery disease.
Department of Adult Cardiology, Heart Hospital, Hamad Medical Corporation (HMC), Doha, Qatar. jalsuwaidi@hotmail.com
Jassim
J
Al Suwaidi
Khalid
K
Al Habib
Rajvir
R
Singh
Ahmad
A
Hersi
Khalid
K
Al Nemer
Nidal
N
Asaad
Shukri
S
Al Saif
Ahmed
A
Al-Motarreb
Wael
W
Almahmeed
Kadhim
K
Sulaiman
Haitham
H
Amin
Jawad
J
Al-Lawati
Nizar
N
Al Bustani
Norah Q
NQ
Al-Sagheer
Waleed M
WM
Ali
D054058:Acute Coronary Syndrome / Q000453:epidemiology*; D017677:Age Distribution; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D050171:Dyslipidemias / Q000453:epidemiology*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D012042:Registries; D018570:Risk Assessment; D017678:Sex Distribution; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*; D062789:Tobacco Products / Q000009:adverse effects / Q000706:statistics & numerical data*; D014029:Tobacco Use Disorder / Q000453:epidemiology*; D014030:Tobacco, Smokeless / Q000009:adverse effects / Q000706:statistics & numerical data*