title: The association between smoking and long-term outcomes after non-ST-segment elevation myocardial infarction in older patients.
abstract: BACKGROUND
  Prior studies have observed that smokers have paradoxically favorable 1-year mortality rates after acute coronary syndromes, but it is unknown whether this association extends to long-term outcomes and to older patients.
  
  
  METHODS
  We identified 38,628 patients aged ≥65 years participating in the CRUSADE Registry between February 2003 and December 2006 with non-ST-segment elevation myocardial infarction and linked these patients to Medicare claims data to assess longitudinal outcomes. Cox proportional hazard models were used to examine the association between smoking, 30-day, and long-term outcomes.
  
  
  RESULTS
  Overall, 4,876 (13%) were current/recent smokers and 33,752 (87%) were nonsmokers. Compared with nonsmokers, smokers were younger and more likely to be male and to receive in-hospital revascularization (all P < .001) but less likely to have hypertension, diabetes mellitus, and renal insufficiency. Compared with nonsmokers, the unadjusted 30-day mortality was lower (8.7% vs 10.3%, P = .0004), but the adjusted 30-day mortality was similar (adjusted hazard ratio [HR] 1.08, 95% CI 0.97-1.20). Over a median of 3.6 years of follow-up, smokers had lower crude long-term mortality rates (53% vs 55% at 6 years, P = .001) but significantly higher long-term mortality rates after adjustment (adjusted HR 1.28, 95% CI 1.21-1.34). Smokers also had higher risks of all-cause readmission (HR 1.13, 95% CI 1.09-1.17) and recurrent myocardial infarction (HR 1.23, 95% CI 1.13-1.34).
  
  
  CONCLUSIONS
  Among older non-ST-segment elevation myocardial infarction patients, we found that smokers had significantly higher long-term risks for both mortality and recurrent myocardial infarction. These results support ongoing efforts to promote smoking cessation, even among older patients.
authors.affiliation: Department of Cardiology, Shanghai Renji Hospital, Shanghai, China; The Duke Clinical Research Institute, Durham, NC.
authors.forename: Lan
authors.initials: L
authors.lastname: Shen
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Shuang
authors.initials: S
authors.lastname: Li
authors.forename: Laine
authors.initials: L
authors.lastname: Thomas
authors.forename: Karen
authors.initials: K
authors.lastname: Alexander
authors.forename: Ying
authors.initials: Y
authors.lastname: Xian
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Wang
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Roe
authors.forename: Ben
authors.initials: B
authors.lastname: He
authors.forename: Bimal R
authors.initials: BR
authors.lastname: Shah
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology / Q000401:mortality*; D014481:United States / Q000453:epidemiology