TY - JOUR
T1 - 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)
AU - Gennaro, Giustino
AU - Brener, Sorin J
AU - Redfors, Björn
AU - Kirtane, Ajay J
AU - Généreux, Philippe
AU - Maehara, Akiko
AU - Neunteufl, Thomas
AU - Metzger, D Christopher
AU - Mehran, Roxana
AU - Gibson, C Michael
AU - Stone, Gregg W
N1 - Funding Information:
Dr. Kirtane receives institutional research grants to Columbia University from Boston Scientific, Medtronic, Abbott Vascular, Abiomed, St. Jude Medical, Vascular Dynamics, and Eli Lilly. Dr. Généreux receives speaker fee from Abbott Vascular and Edwards Lifescience; consulting fee from Cardiovascular Systems Inc., PiCardia; and institutional research grant from Boston Scientific. Dr. Maehara receives grant support from Boston Scientific; is a consultant for Boston Scientific, ACIST Medical Systems; receives speaker fee from St. Jude Medical. Dr. Neunteufl receives consulting and lecture fees from AstraZeneca, Abbott Vascular, Atrium Medical Corporation, Bayer, Boehringer Ingelheim, Biosensors International, Biotronik, BMS/Sanofi-Aventis, Boston Scientific, Edwards Lifesciences, Eli Lilly, Daiichi Sankyo, Maquet, Medtronic, Menarini, St. Jude. Dr. Metzger receives symposium honoraria from Abbott Vascular, Boston Scientific. Dr. Mehran receives research grant support from Eli Lilly, AstraZeneca, The Medicines Company, BMS/Sanofi-Aventis, DSI, OrbusNeich; consulting fee from AstraZeneca, Bayer, CSL Behring, Janssen Pharmaceuticals Inc., Merck & Co., Osprey Medical Inc., Watermark Research Partners; is a member of Scientific Advisory Board of Abbott Laboratories, Boston Scientific Corporation, Covidien, Janssen Pharmaceuticals, The Medicines Company, Sanofi-Aventis. Dr. Gibson receives research grant from Angel Medical Corporation, Atrium Medical Systems, Bayer, Bristol Meyers, Squibb Company, Ikaria, Inc., Janssen Pharmaceuticals, Johnson & Johnson Corporation, Lantheus Medical Imaging, Medtronic Vascular, Inc., Portola Pharmaceuticals, Stealth Peptides, Inc., St. Jude Medical, Volcano Corp, Walk Vascular. Consultant honorariums: Atrium Medical Systems, Baxter Healthcare, Boehringer Ingelheim, Bristol-Myers Squibb Company, Cardiovascular Research Foundation, CSL Behring, Cytori Therapeutics, Daiichi Sankyo Company, Inc., Eli Lilly and Company, Exeter Group, Google Inc., Navigant, St. Jude Medical, The Medicines Company, WebMD. The other authors have no conflicts of interest to disclose.
Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2016/10/15
Y1 - 2016/10/15
N2 - 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.
AB - 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.
KW - Abciximab
KW - Age Distribution
KW - Aged
KW - Anterior Wall Myocardial Infarction/diagnostic imaging
KW - Antibodies, Monoclonal/therapeutic use
KW - Case-Control Studies
KW - Female
KW - Humans
KW - Hypertension/epidemiology
KW - Immunoglobulin Fab Fragments/therapeutic use
KW - Injections, Intra-Arterial
KW - Kaplan-Meier Estimate
KW - Linear Models
KW - Magnetic Resonance Imaging
KW - Male
KW - Middle Aged
KW - Mortality
KW - Multivariate Analysis
KW - Myocardial Revascularization/statistics & numerical data
KW - Percutaneous Coronary Intervention/methods
KW - Platelet Aggregation Inhibitors/therapeutic use
KW - Proportional Hazards Models
KW - Randomized Controlled Trials as Topic
KW - Recurrence
KW - ST Elevation Myocardial Infarction/diagnostic imaging
KW - Severity of Illness Index
KW - Sex Distribution
KW - Smoking/epidemiology
KW - Stroke/epidemiology
KW - Thrombectomy/methods
KW - Treatment Outcome
UR - http://www.scopus.com/inward/record.url?scp=84995807208&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2016.07.019
DO - 10.1016/j.amjcard.2016.07.019
M3 - Journal article
C2 - 27553094
SN - 0002-9149
VL - 118
SP - 1097
EP - 1104
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 8
ER -