The tobacco paradox in acute coronary syndrome. The prior cessation of smoking as a marker of a better short-term prognosis.
OBJECTIVE
The tobacco paradox is a phenomenon insufficiently explained by previous studies. This study analyses the prognostic role of prior or active smoking in patients with acute coronary syndrome.


METHODS
We obtained data from the ARIAM registry, between 2001 and 2012. The study included 42,827 patients with acute coronary syndrome (mean age, 65±13 years; 26.4% women). The influence of smoking and that of being an ex-smoker on mortality was analysed using a multivariate analysis.


RESULTS
The smokers were younger, were more often men, had less diabetes, hypertension and prior history of heart failure, stroke, arrhythmia and renal failure and more frequently had ST-elevation and a family history of smoking. The ex-smokers had more dyslipidaemia and history of angina, myocardial infarction, ischemic heart disease, peripheral vasculopathy and chronic bronchial disease. Smokers and ex-smokers less frequently developed cardiogenic shock (smokers 4.2%, ex-smokers 4.7% and nonsmokers 6.9%, P<.001). Hospital mortality was 7.8% for the nonsmokers, 4.9% for the ex-smokers and 3.1% for the smokers (P<.001). In the multivariate analysis, the smoker factor lost its influence in the prognosis (-0.26%, p=.52 using an inverse probability calculation; and+0.26%, P=.691 using a propensity analysis). However, the exsmoker factor showed a significant reduction in mortality in both tests (-2.4% in the inverse probability analysis, P<.001; and -1.5% in the propensity analysis, P=.005).


CONCLUSIONS
The tobacco paradox is a finding that could be explained by other prognostic factors. Smoking cessation prior to hospitalization for acute coronary syndrome is associated with a better prognosis.
Unidad de Gestión de Cardiología, Hospitales Universitarios Virgen Macarena-Virgen del Rocío, Sevilla, España.
P
P
Bastos-Amador
Unidad de Gestión de Cardiología, Hospitales Universitarios Virgen Macarena-Virgen del Rocío, Sevilla, España.
M
M
Almendro-Delia
Unidad de Gestión de Cardiología, Hospitales Universitarios Virgen Macarena-Virgen del Rocío, Sevilla, España.
B
B
Muñoz-Calero
Unidad de Cuidados Intensivos, Hospital Virgen de las Nieves, Granada, España.
E
E
Blanco-Ponce
Unidad de Cuidados Intensivos, Hospital Virgen de las Nieves, Granada, España.
A
A
Recio-Mayoral
Unidad de Cuidados Intensivos, Hospital Virgen de las Nieves, Granada, España.
A
A
Reina-Toral
Unidad de Cuidados Intensivos, Hospital Virgen de la Victoria, Málaga, España.
J M
JM
Cruz-Fernandez
Unidad de Cuidados Intensivos, Hospital Virgen de la Victoria, Málaga, España.
A
A
García-Alcántara
Unidad de Gestión de Cardiología, Hospitales Universitarios Virgen Macarena-Virgen del Rocío, Sevilla, España.
R
R
Hidalgo-Urbano
Unidad de Gestión de Cardiología, Hospitales Universitarios Virgen Macarena-Virgen del Rocío, Sevilla, España. Electronic address: grubira1@gmail.com.
J C
JC
García-Rubira
Abandono tabaquismo; Acute coronary syndrome; Acute myocardial infarction; Factores de riesgo; Infarto agudo de miocardio; Prognosis; Pronóstico; Risk factors; Smoking; Smoking cessation; Síndrome coronario agudo; Tabaquismo