title: Prognostic Factors in Patients With Stemi Undergoing Primary PCI in the Clopidogrel Era: Role of Dual Antiplatelet Therapy at Admission and the Smoking Paradox on Long-Term Outcome.
abstract: BACKGROUND
  Several clinical and laboratory variables have an impact on the prognosis of STEMI patients undergoing PPCI; however, little is known about the role of ongoing DAPT at the time of the event and the smoking status as prognostic factors affecting the outcome of these patients.
  
  
  RESULTS
  Seven-hundred and thirteen consecutive STEMI patients undergoing PPCI, admitted to the S. Anna and S. Sebastiano Hospital (Caserta, Italy) and to the OLV Clinic (Aalst, Belgium), between March 2009 and December 2011, were retrospectively enrolled. Rescue PCI was the only exclusion criterion. Primary end-point was the combination of death for all causes, re-infarction, stroke, and target lesion revascularization (TLR). Patients already on DAPT at admission (26.4%) showed a significant increase in the event rate at univariate analysis (HR 2.34, CI 1.62-3.75, P < 0.05), while current smokers (56.5%) had a lower event rate, as compared to non-smokers (HR 0.67, CI 0.46-0.96, P < 0.05). In smoking patients already on DAPT at admission, a lower event rate was observed than in non-smoking patients on DAPT. Although, patients already on DAPT had a higher-risk profile (renal impairment, ongoing statin treatment, ST resolution <50%, and Killip class >1 were more frequently present than in patients not on DAPT), Cox regression analysis confirmed that both DAPT (HR 1.74, 95%CI 1.20-2.53, P < 0.01) and smoking status (HR 0.69, 95%CI 0.48-1.00, P < 0.05) retained their statistical significance, as they and were significantly associated with a worse and a better outcome, respectively, underlying their role as independent prognostic factors.
  
  
  CONCLUSIONS
  Not being a current smoker and ongoing DAPT at admission, in patients with STEMI undergoing PPCI, represent independent negative prognostic value.
authors.affiliation: Department of Cardio-Thoracic Sciences, Section of Cardiology, Second University of Naples, Naples, Italy.|Cardiovascular Center, OLV Clinic, Aalst, Belgium.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ciccarelli
authors.affiliation: Cardiovascular Center, OLV Clinic, Aalst, Belgium.|Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Barbato
authors.affiliation: Department of Cardio-Thoracic Sciences, Section of Cardiology, Second University of Naples, Naples, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Golino
authors.affiliation: Department of Cardio-Thoracic Sciences, Section of Cardiology, Second University of Naples, Naples, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cimmino
authors.affiliation: Cardiovascular Center, OLV Clinic, Aalst, Belgium.
authors.forename: Jozef
authors.initials: J
authors.lastname: Bartunek
authors.affiliation: Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Serafino
authors.affiliation: AORN S. Anna e S. Sebastiano, Caserta, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Di Girolamo
authors.affiliation: Cardiovascular Center, OLV Clinic, Aalst, Belgium.
authors.forename: Bernard
authors.initials: B
authors.lastname: De Bruyne
authors.affiliation: Cardiovascular Center, OLV Clinic, Aalst, Belgium.
authors.forename: William
authors.initials: W
authors.lastname: Wijns
authors.affiliation: Department of Cardio-Thoracic Sciences, Section of Cardiology, Second University of Naples, Naples, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Golino
mesh_terms: D000368:Aged; D001530:Belgium; D000077144:Clopidogrel; D005260:Female; D006760:Hospitalization; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011379:Prognosis; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D012907:Smoking; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine