Smoker's Paradox in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.
Prior studies have found that smokers undergoing thrombolytic therapy for ST-segment elevation myocardial infarction have lower in-hospital mortality than nonsmokers, a phenomenon called the "smoker's paradox." Evidence, however, has been conflicting regarding whether this paradoxical association persists in the era of primary percutaneous coronary intervention.



We used the 2003-2012 National Inpatient Sample databases to identify all patients aged ≥18 years who underwent primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Multivariable logistic regression was used to compare in-hospital mortality between smokers (current and former) and nonsmokers. Of the 985 174 patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention, 438 954 (44.6%) were smokers. Smokers were younger, were more often men, and were less likely to have traditional vascular risk factors than nonsmokers. Smokers had lower observed in-hospital mortality compared with nonsmokers (2.0% versus 5.9%; unadjusted odds ratio 0.32, 95% CI 0.31-0.33, P<0.001). Although the association between smoking and lower in-hospital mortality was partly attenuated after baseline risk adjustment, a significant residual association remained (adjusted odds ratio 0.60, 95% CI 0.58-0.62, P<0.001). This association largely persisted in age-stratified analyses. Smoking status was also associated with shorter average length of stay (3.5 versus 4.5 days, P<0.001) and lower incidence of postprocedure hemorrhage (4.2% versus 6.1%; adjusted odds ratio 0.81, 95% CI 0.80-0.83, P<0.001) and in-hospital cardiac arrest (1.3% versus 2.1%; adjusted OR 0.78, 95% CI 0.76-0.81, P<0.001).



In this nationwide cohort of patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction, we observed significantly lower risk-adjusted in-hospital mortality in smokers, suggesting that the smoker's paradox also applies to ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.
New York Medical College, Valhalla, NY.
Tanush
T
Gupta
Brown University/Rhode Island Hospital, Providence, RI.
Dhaval
D
Kolte
New York Medical College, Valhalla, NY.
Sahil
S
Khera
New York Medical College, Valhalla, NY.
Prakash
P
Harikrishnan
New York Medical College, Valhalla, NY.
Marjan
M
Mujib
New York Medical College, Valhalla, NY wsaronow@aol.com.
Wilbert S
WS
Aronow
New York Medical College, Valhalla, NY.
Diwakar
D
Jain
Veterans Affairs Medical Center, Washington, DC.
Ali
A
Ahmed
New York Medical College, Valhalla, NY.
Howard A
HA
Cooper
New York Medical College, Valhalla, NY.
William H
WH
Frishman
Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA.
Deepak L
DL
Bhatt
David Geffen School of Medicine, University of California at Los Angeles, CA.
Gregg C
GC
Fonarow
New York Medical College, Valhalla, NY.
Julio A
JA
Panza
D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D012907:Smoking / Q000009:adverse effects*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
ST‐segment elevation myocardial infarction; primary percutaneous coronary intervention; smoker's paradox; smoking