title: Impact of active smoking on myocardial infarction severity in reperfused ST-segment elevation myocardial infarction patients: the smoker's paradox revisited.
abstract: To investigate the influence of cardiovascular risk factors (CV-RFs) on infarct severity and post-infarction left ventricular (LV) remodelling in acutely reperfused ST-segment elevation myocardial infarction (STEMI) patients studied with cardiovascular magnetic resonance (CMR).
  
  
  
  Four-hundred seventy-one patients were included in the study. Baseline CMR was performed at 4 ± 1 days after STEMI to assess area-at-risk, infarct size (IS), myocardial salvage index (MSI), microvascular obstruction (MVO), intramyocardial haemorrhage (IMH), LV volumes, and function. Cardiovascular magnetic resonance was repeated 4 months after STEMI (n = 383) to assess adverse LV remodelling (increase of LV end-diastolic volume >20% between baseline and follow-up). Smoking was associated with IMH at baseline even after correction for other factors associated with ischaemia-reperfusion injury including MVO, IS, and MSI (OR: 2.17, 95% CI: 1.17-4.00, P = 0.01). Unexpectedly, smoking was an independent protective predictor against adverse LV remodelling (OR: 0.43, 95% CI: 0.24-0.77, P = 0.005), consistent with the 'smoker's paradox'. However, the presence of IMH at baseline abolished the paradoxical, beneficial effects of smoking with respect to IS, baseline LV function, and post-infarction LV remodelling. No association between other CV-RFs, infarct severity, or post-infarction LV remodelling was observed.
  
  
  
  In patients with reperfused STEMI, smoking is strongly and independently associated with IMH at baseline. Nonetheless, consistent with the 'smoker's paradox', smoking was an independent predictor of more favourable post-infarction LV remodelling. However, the paradoxical beneficial effects of smoking were lost in patients with IMH.
authors.affiliation: Department of Imaging and Pathology, Medical Imaging Research Centre, University Hospitals, Herestraat 49, 3000 Leuven, Belgium rolf.symons@uzleuven.be.
authors.forename: Rolf
authors.initials: R
authors.lastname: Symons
authors.affiliation: Centre for Cardiovascular Magnetic Resonance, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Pier Giorgio
authors.initials: PG
authors.lastname: Masci
authors.affiliation: Department of Radiological, Oncological, and Pathological Sciences, La Sapienza University, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Francone
authors.affiliation: Department of Imaging and Pathology, Medical Imaging Research Centre, University Hospitals, Herestraat 49, 3000 Leuven, Belgium.
authors.forename: Piet
authors.initials: P
authors.lastname: Claus
authors.affiliation: MRI Department, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Barison
authors.affiliation: Department of Radiological, Oncological, and Pathological Sciences, La Sapienza University, Rome, Italy.
authors.forename: Iacopo
authors.initials: I
authors.lastname: Carbone
authors.affiliation: Department of Radiological, Oncological, and Pathological Sciences, La Sapienza University, Rome, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Agati
authors.affiliation: Department of Radiological, Oncological, and Pathological Sciences, La Sapienza University, Rome, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Galea
authors.affiliation: Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Stefan
authors.initials: S
authors.lastname: Janssens
authors.affiliation: Department of Imaging and Pathology, Medical Imaging Research Centre, University Hospitals, Herestraat 49, 3000 Leuven, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Bogaert
mesh_terms: D006801:Humans; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction; D000074285:Smokers; D012907:Smoking
keywords: Cardiovascular risk factors; Left ventricular remodelling; Myocardial infarction; Smoker's paradox