title: Temporal trends in all-cause mortality of smokers versus non-smokers hospitalized with ST-segment elevation myocardial infarction.
abstract: OBJECTIVE
  Over the past decade, the development of novel management strategies has resulted in improved outcomes among patients hospitalized with ST-segment myocardial infarction (STEMI). The aim of the present study was to compare temporal trends in the mortality of smokers versus non-smokers admitted with STEMI in a real world setting between 2000 and 2010.
  
  
  METHODS
  We evaluated time-dependent changes in the clinical characteristics, management strategies, and one year all-cause mortality of STEMI patients who were enrolled in the biannual Acute Coronary Syndrome Israeli Survey (ACSIS) between 2000 and 2010, categorized as smokers (n=2399) and non-smokers (n=3069). We divided the survey periods into early (2000-2004) and late (2006-2010). The primary endpoint of the study was the occurrence of one-year all-cause mortality.
  
  
  RESULTS
  A total of 4564 STEMI patients were enrolled in the study. Compared with non-smokers, smokers were significantly younger and displayed a significantly lower rate of all-cause mortality at 30 days and 1-year. Both smokers and non-smokers who were enrolled in the late survey period received more evidence-based therapies (primary PCI and guideline-based medications) (p<0.001 for all). There was a significant reduction in the risk of 1-year all-cause mortality only among non-smokers (HR=0.664 CI 95% 0.52-0.85, p=0.0009), whereas smokers who were enrolled in more recent survey periods did not display a significant risk reduction (HR=1.08 CI 95% 0.77-1.51, p=0.67).
  
  
  CONCLUSIONS
  Survival following STEMI among smokers has not improved over the past decade despite corresponding changes in management strategies. Future trials should focus on reducing the risk in smokers.
authors: Department of Cardiology, Tel Aviv Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv, Tel Aviv University, Israel. Electronic address: yarona@tlvmc.gov.il.
authors: Yaron
authors: Y
authors: Arbel
authors: Department of Cardiology, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv, Tel Aviv University, Israel.
authors: Shlomi
authors: S
authors: Matetzky
authors: Department of Cardiology, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv, Tel Aviv University, Israel.
authors: Natalie
authors: N
authors: Gavrielov-Yusim
authors: Department of Cardiology, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv, Tel Aviv University, Israel.
authors: Meital
authors: M
authors: Shlezinger
authors: Department of Cardiology, Tel Aviv Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv, Tel Aviv University, Israel.
authors: Gad
authors: G
authors: Keren
authors: Department of Cardiology, Tel Aviv Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv, Tel Aviv University, Israel.
authors: Arie
authors: A
authors: Roth
authors: Department of Cardiology, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv, Tel Aviv University, Israel.
authors: Eran
authors: E
authors: Kopel
authors: Department of Cardiology, Tel Aviv Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv, Tel Aviv University, Israel.
authors: Ariel
authors: A
authors: Finkelstein
authors: Department of Cardiology, Tel Aviv Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv, Tel Aviv University, Israel.
authors: Shmuel
authors: S
authors: Banai
authors: Department of Cardiology, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv, Tel Aviv University, Israel.
authors: Robert
authors: R
authors: Klempfner
authors: Department of Cardiology, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv, Tel Aviv University, Israel.
authors: Ilan
authors: I
authors: Goldenberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003625:Data Collection / Q000639:trends; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality*; D011446:Prospective Studies; D012907:Smoking / Q000401:mortality* / Q000639:trends*; D013997:Time Factors
keywords: Mortality; Primary PCI; STEMI; Smoker's paradox; Smoking; Trends