title: Change in left ventricular systolic function in patients with ST elevation myocardial infarction: Evidence for smoker's paradox or pseudo-paradox?
abstract: BACKGROUND
  The 'smoker's paradox' refers to the observation of favorable prognosis in current smokers following an acute ST elevation myocardial infarction (STEMI) in the era of fibrinolysis, however, several STEMI studies have demonstrated conflicting results in patients undergoing primary percutaneous coronary intervention (p-PCI).
  
  
  OBJECTIVE
  Aim of the current study was to evaluate the impact of cigarette smoking on left ventricular function in STEMI patients undergoing p-PCI.
  
  
  METHODS
  Our population is represented by 74 first-time anterior STEMI patients undergoing p-PCI, 37 of whom were smokers. We assessed left ventricular function by left ventricular ejection fraction (LVEF) on the second day after admission and at 3-month follow-up. Early predictors of adverse left ventricular remodelling after STEMI treated by p-PCI were examined.
  
  
  RESULTS
  Basal demographics and comorbidities were similar between groups. Although the LVEF during the early phase was higher in smokers compared to non-smokers (44.95±7.93% vs. 40.32±7.28%; p=0.011); it worsened in smokers at follow-up (mean decrease in LVEF: -2.70±5.95%), whereas it improved in non-smokers (mean recovery of LVEF: +2.97±8.45%). In univariate analysis, diabetes mellitus, peak troponin I, current smoking, and lower TIMI flow grade after p-PCI, pain-to-door time and door-to-balloon times were predictors of adverse left ventricular remodelling. After multivariate logistic regression analysis, smoking at admission, lower TIMI flow grade after p-PCI, the pain-to-door time and door-to-balloon times remained independent predictors of deterioration in LVEF.
  
  
  CONCLUSIONS
  True or persistent 'smoker's paradox' does not appear to be relevant among STEMI patients undergoing p-PCI. The 'smoker's paradox' is in fact a pseudo-paradox. Further studies with larger numbers may be warranted.
authors.affiliation: Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey.
authors.forename: Burak
authors.initials: B
authors.lastname: Acar
authors.affiliation: Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey. Electronic address: ozcanozeke@gmail.com.
authors.forename: Ozcan
authors.initials: O
authors.lastname: Ozeke
authors.affiliation: Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey.
authors.forename: Sefa
authors.initials: S
authors.lastname: Unal
authors.affiliation: Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Karakurt
authors.affiliation: Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey.
authors.forename: Meryem
authors.initials: M
authors.lastname: Kara
authors.affiliation: Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Kirbas
authors.affiliation: Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Sen
authors.affiliation: Numune Training and Research Hospital, Department of Cardiology, Ankara, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Korkmaz
authors.affiliation: Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey.
authors.forename: Dursun
authors.initials: D
authors.lastname: Aras
authors.affiliation: Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey.
authors.forename: Sinan
authors.initials: S
authors.lastname: Aydogdu
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D000072657:ST Elevation Myocardial Infarction / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D012907:Smoking / Q000009:adverse effects*; D013318:Stroke Volume / Q000502:physiology*; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*; D020257:Ventricular Remodeling / Q000502:physiology*
keywords: Cigarette smoking; Primary percutaneous coronary intervention; ST elevation myocardial infarction; Smoker's paradox