title: "Smoker's paradox" in patients with cardiogenic shock complicating myocardial infarction - A substudy of the IABP-SHOCK II-trial and registry.
abstract: BACKGROUND
  Several studies in patients with acute myocardial infarction (AMI) without cardiogenic shock (CS) indicate a better survival in smokers, the so called "smoker's paradox". For CS, this relationship has not been investigated so far in the primary percutaneous coronary intervention (PCI) era.
  
  
  METHODS
  In a predefined substudy of the Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial and its accompanying registry including patients with CS complicating AMI we investigated differences in outcome of smokers compared to non-smokers. All-cause-mortality at 1year was used as primary endpoint.
  
  
  RESULTS
  Of 772 patients with available smoking status 263 patients were smokers (34%). Smokers were more often male (79% vs. 65%; p<0.001), of younger age (61 [interquartile range IQR 52-70] vs. 73 [IQR 64-79] years; p<0.001), had less comorbidity including arterial hypertension (62% vs. 71%; p=0.007) and diabetes mellitus (26% vs. 38%; p<0.001) and had lower levels of serum creatinine (13% vs. 25%; p<0.001). There was no significant difference between the 2 groups regarding left ventricular ejection fraction, initial revascularization strategy or use of IABP. Smokers had lower rates of mortality at 12months in univariable analysis (43% vs. 59%; p<0.001) but not after adjustment for important confounders using Cox-regression analysis (hazard ratio 0.77, 95% confidence interval 0.59-1.03; p=0.08).
  
  
  CONCLUSIONS
  Smoking is not predictive of outcome in patients with CS complicating AMI. The observed survival benefit in univariable analysis seems to be explained by the younger age and lower risk profile of smokers.
authors: Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany. Electronic address: mohammed.saad@uksh.de.
authors: Mohammed
authors: M
authors: Saad
authors: Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
authors: Georg
authors: G
authors: Fuernau
authors: Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
authors: Steffen
authors: S
authors: Desch
authors: Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
authors: Ingo
authors: I
authors: Eitel
authors: University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany.
authors: Christian
authors: C
authors: Jung
authors: Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
authors: Janine
authors: J
authors: Pöss
authors: Klinikum Ludwigshafen and Institut für Herzinfarktforschung, Ludwigshafen, Germany.
authors: Steffen
authors: S
authors: Schneider
authors: University of Leipzig - Heart Center, Leipzig, Germany.
authors: Gerhard
authors: G
authors: Schuler
authors: Department of Medicine III, Martin-Luther University Halle-Wittenberg, Halle, Germany.
authors: Karl
authors: K
authors: Werdan
authors: Klinikum Ludwigshafen and Institut für Herzinfarktforschung, Ludwigshafen, Germany.
authors: Uwe
authors: U
authors: Zeymer
authors: Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
authors: Holger
authors: H
authors: Thiele
mesh_terms: D000368:Aged; D005260:Female; D005858:Germany / Q000453:epidemiology; D006353:Heart-Assist Devices; D006801:Humans; D015994:Incidence; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000601:surgery; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011379:Prognosis; D012042:Registries; D012770:Shock, Cardiogenic / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D012907:Smoking / Q000009:adverse effects*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: Caridogenic shock; Myocardial infarction; Outcome; Smoker's paradox; Smoking