title: Cigarette smoking is paradoxically associated with low mortality risk after acute myocardial infarction.
abstract: BACKGROUND
  Cigarette smoking has been shown to be associated with a decreased risk of death after acute myocardial infarction (AMI), which is also known as the "smokers' paradox." This study aimed to investigate the relationship between smoking and all-cause mortality after AMI.
  
  
  METHODS
  We extracted the data of patients who were hospitalized for AMI between November 2005 and September 2010 from nationwide multicenter prospective registries in Korea.
  
  
  RESULTS
  Among a total of 29,199 patients with AMI, 10,251 (42.3%) were current smokers, and 14,006 (57.7%) were nonsmokers. Current smokers were younger, more likely to be male, and had lower frequencies of hypertension, diabetes mellitus, dyslipidemia, and previous history of ischemic heart disease than nonsmokers. The initial presentation was less severe in terms of hemodynamic status, and angiography showed less complex coronary involvement in smokers. The overall mortality rate was 5.4% for current smokers and 9.9% for nonsmokers (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.47-0.58; p < .001). The gap in risk was attenuated after multivariable adjustment but remained statistically significant (HR, 0.85; 95% CI, 0.76-0.95; p = .005). Propensity score matching corroborated the results of reduced mortality among current smokers (6.7% vs. 7.6%; p = .005).
  
  
  CONCLUSIONS
  In this study, in which the patients received up-to-date treatment options, smoking was associated with a 48% decrease in the risk of all-cause mortality at 1 year after AMI.
authors.affiliation: Department of Internal Medicine and Cardiovascular Center, Seoul National University Bundang Hospital, Gyeonggido, Republic of Korea.
authors.forename: Si-Hyuck
authors.initials: SH
authors.lastname: Kang
authors.forename: Jung-Won
authors.initials: JW
authors.lastname: Suh
authors.forename: Dong-Ju
authors.initials: DJ
authors.lastname: Choi
authors.forename: In-Ho
authors.initials: IH
authors.lastname: Chae
authors.forename: Goo-Yeong
authors.initials: GY
authors.lastname: Cho
authors.forename: Tae-Jin
authors.initials: TJ
authors.lastname: Youn
authors.forename: Young-Seok
authors.initials: YS
authors.lastname: Cho
authors.forename: Chang-Hwan
authors.initials: CH
authors.lastname: Yoon
authors.forename: Il-Young
authors.initials: IY
authors.lastname: Oh
authors.forename: Myeong Chan
authors.initials: MC
authors.lastname: Cho
authors.forename: Young Jo
authors.initials: YJ
authors.lastname: Kim
authors.forename: Shung Chull
authors.initials: SC
authors.lastname: Chae
authors.forename: Joo Han
authors.initials: JH
authors.lastname: Kim
authors.forename: Young-Keun
authors.initials: YK
authors.lastname: Ahn
authors.forename: Myung-Ho
authors.initials: MH
authors.lastname: Jeong
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D012907:Smoking / Q000401:mortality*