title: Smokers with ST-segment elevation myocardial infarction and short time to treatment have equal effects of PCI and fibrinolysis.
abstract: OBJECTIVE
  The purpose of this study was to examine the effect of primary percutaneous coronary intervention (PCI) compared to fibrinolysis in smokers and non-smokers with ST-segment elevation myocardial infarction (STEMI). Smokers seem to have less atherosclerosis but are more prone to thrombotic disease. Compared to non-smokers, they have higher rates of early, complete reperfusion when treated with fibrinolysis for MI.
  
  
  RESULTS
  In the Second Danish Multicenter Trial in Acute Myocardial Infarction (DANAMI-2), a total of 1572 patients with STEMI were randomized to either fibrinolysis or PCI (1129 patients were enrolled at 24 referral hospitals and 443 patients at 5 invasive treatment centers). The primary endpoint for this substudy was death by any cause. Secondary endpoints were a composite of death by any cause, clinical re-infarction or disabling stroke. Follow-up was 3 years. The effect of PCI is reported according to time to treatment and smoking status. Data on smoking habits were available for 1534 patients (895 smokers and 639 non-smokers). Smokers with short time to treatment (<3 hours) benefited equally from PCI and fibrinolysis with a trend toward higher mortality in the PCI group (mortality [hazard ratio, 1.64 (0.79-3.41); P=.18], composite endpoint [hazard ratio, 1.06 (0.65-1.71); P=.82]). In non-smokers with short time to treatment PCI was superior to fibrinolysis (mortality [hazard ratio, 0.46 (0.22-0.93); P=.02], combined endpoint [hazard ratio, 0.45 (0.26- 0.79); P=.004]). Patients with >3 hours to treatment all showed a tendency toward a superior effect of PCI irrespective of smoking habits.
  
  
  CONCLUSIONS
  PCI and fibrinolysis are equally beneficial in smokers with STEMI and short time to treatment.
authors.affiliation: Department of Cardiology, Rigshospitalet, University of Copenhagen, Cardiology, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark 2100. drrasmussen@hotmail.com
authors.forename: Thomas
authors.initials: T
authors.lastname: Rasmussen
authors.forename: Henning
authors.initials: H
authors.lastname: Kelbæk
authors.forename: Jan Kyst
authors.initials: JK
authors.lastname: Madsen
authors.forename: Per
authors.initials: P
authors.lastname: Thayssen
authors.forename: Klaus
authors.initials: K
authors.lastname: Rasmussen
authors.forename: Leif
authors.initials: L
authors.lastname: Thuesen
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
mesh_terms: D000368:Aged; D002423:Cause of Death; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012008:Recurrence; D012907:Smoking / Q000009:adverse effects / Q000401:mortality / Q000503:physiopathology; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D061665:Time-to-Treatment; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents