title: Association of smoking with myocardial injury and clinical outcome in patients undergoing mechanical reperfusion for ST-elevation myocardial infarction.
abstract: OBJECTIVE
  There is evidence suggesting a positive effect of cigarette smoking on myocardial tissue reperfusion and clinical outcomes in patients with myocardial infarction ('smoker's paradox'). We aimed to evaluate the relationship of smoking with cardiac magnetic resonance (CMR)-determined myocardial salvage and damage as well as clinical outcomes in patients undergoing primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI).
  
  
  RESULTS
  This multicentre study included 727 consecutive STEMI patients reperfused within 12 h after symptom onset. CMR imaging parameters [area at risk (AAR), infarct size (IS), myocardial salvage index (MSI), and microvascular obstruction (MVO) and intramyocardial haemorrhage (IMH)] were compared according to admission smoking status. Major adverse cardiac event (MACE) rates at 12 months after infarction were compared between groups. Three hundred and thirty-nine (46.6%) patients were current smokers. There was no difference in the extent of AAR [35 (24-47) vs. 37 (27-49) % of left ventricular volume (LV), P = 0.10], IS [16 (8-25) vs. 17 (10-26) %LV, P = 0.21], MSI [53 (29-70) vs. 52 (34-71), P = 0.47], MVO [0 (0-1.7) vs. 0 (0-1.6) %LV, P = 0.91], or in the frequency of IMH (42 vs. 39%, P = 0.58) between smokers and non-smokers. Smokers had lower MACE (3.8 vs. 8.2%, P = 0.01) rates. However, adjustment for differences in baseline risk factors attenuated the association of smoking with MACE markedly (hazard ratio = 0.71, 95% confidence interval 0.36-1.38, P = 0.31).
  
  
  CONCLUSIONS
  Smoking is not associated with PPCI efficacy (myocardial salvage) or irreversible myocardial damage in patients with STEMI. The lower MACE rate of smokers was entirely explained by differences in baseline risk characteristics, thus challenging the existence of a smoker's paradox.
authors.affiliation: University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology, and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany.|German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany.|University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck 6020, Austria.
authors.forename: Sebastian J
authors.initials: SJ
authors.lastname: Reinstadler
authors.affiliation: University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology, and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany.|German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Eitel
authors.affiliation: University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology, and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany.|German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Fuernau
authors.affiliation: University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology, and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany.|German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany.
authors.forename: Suzanne
authors.initials: S
authors.lastname: de Waha
authors.affiliation: University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology, and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany.|German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Desch
authors.affiliation: Clinical Trial Center Leipzig, University of Leipzig, Leipzig 04289, Germany.
authors.forename: Meinhard
authors.initials: M
authors.lastname: Mende
authors.affiliation: University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, Innsbruck 6020, Austria.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Metzler
authors.affiliation: Department of Cardiology, Heart Center University Leipzig, Leipzig 04289, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.affiliation: University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology, and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany.|German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
authors.affiliation: University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology, and Intensive Care Medicine, University of Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany ingoeitel@gmx.de.|German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Eitel
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000401:mortality; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion / Q000379:methods*; D009206:Myocardium / Q000473:pathology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects*; D015996:Survival Rate; D016896:Treatment Outcome
keywords: ST-elevation myocardial infarction; magnetic resonance imaging; prognosis; smoker’s paradox; smoking