title: Effect of Smoking on Infarct Size and Major Adverse Cardiac Events in Patients With Large Anterior ST-Elevation Myocardial Infarction (from the INFUSE-AMI Trial).
abstract: We sought to investigate the effect of smoking on infarct size (IS) and major adverse cardiac events (MACE) in patients with large anterior ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Participants from the Intracoronary Abciximab and Aspiration Thrombectomy in Patients with Large Anterior Myocardial Infarction study were categorized according to smoking status (current or previous smoking vs no history of smoking). The primary imaging outcome was cardiac magnetic resonance imaging-assessed IS of left ventricular mass (%) at 30 days. The primary clinical outcome was the rate of MACE at 30 days and 1 year, defined as the composite of death, reinfarction, new-onset heart failure, or rehospitalization. Of 447 patients enrolled in Intracoronary Abciximab and Aspiration Thrombectomy in Patients with Large Anterior Myocardial Infarction, 271 (60.6%) were current or past smokers. Compared with nonsmokers, smokers were almost 10 years younger and had a lower prevalence of clinical co-morbidities. Smokers had better procedural success and angiographic reperfusion compared with nonsmokers. At 30 days, there were no differences between smokers and nonsmokers in median IS (16.8% vs 17.4%, p = 0.67) or metrics of left ventricular function. By multivariable linear regression analysis, smoking was not significantly associated with IS at 30 days (beta coefficient: 0.83, p = 0.42). At 1 year, smokers had lower crude rates of MACE (7.6% vs 15%, p = 0.01). After multivariable adjustment, there were no significant differences in 1-year MACE between smokers and nonsmokers (adjusted hazard ratio 0.73, 95% CI 0.40 to 1.33, p = 0.30). In conclusion, smoking history had no significant effect on IS at 30 days. Although current or previous smokers had lower rates of 1-year MACE than those with no history of smoking, adjustment for baseline characteristics rendered this association nonsignificant. These findings support the hypothesis that the smoker's paradox is largely attributable to differences in demographic and clinical baseline risk, rather than differences in IS after primary percutaneous coronary intervention.
authors.affiliation: Department of Medicine, Interventional Cardiovascular Research and Clinical Trials, Icahn School of Medicine at Mount Sinai, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.
authors.forename: Giustino
authors.initials: G
authors.lastname: Gennaro
authors.affiliation: Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Department of Medicine, New York Methodist Hospital, Brooklyn, New York. Electronic address: sjb9005@nyp.org.
authors.forename: Sorin J
authors.initials: SJ
authors.lastname: Brener
authors.affiliation: Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.
authors.forename: Björn
authors.initials: B
authors.lastname: Redfors
authors.affiliation: Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Department of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, New York.
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.affiliation: Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Department of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, New York; Department of Medicine, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Généreux
authors.affiliation: Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Department of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, New York.
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
authors.affiliation: Department of Medicine, Universitätsklinikum Krems, Krems, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Neunteufl
authors.affiliation: Department of Medicine, Wellmont Central Valley Area Heart Institute, Kingsport, Tennessee.
authors.forename: D Christopher
authors.initials: DC
authors.lastname: Metzger
authors.affiliation: Department of Medicine, Interventional Cardiovascular Research and Clinical Trials, Icahn School of Medicine at Mount Sinai, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.affiliation: Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: C Michael
authors.initials: CM
authors.lastname: Gibson
authors.affiliation: Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Department of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, New York.
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D000077284:Abciximab; D017677:Age Distribution; D000368:Aged; D056988:Anterior Wall Myocardial Infarction / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D007269:Injections, Intra-Arterial; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D062645:Percutaneous Coronary Intervention / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D012720:Severity of Illness Index; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology*; D020521:Stroke / Q000453:epidemiology; D017131:Thrombectomy / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077284:Abciximab