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)

Giustino Gennaro, Sorin J Brener, Björn Redfors, Ajay J Kirtane, Philippe Généreux, Akiko Maehara, Thomas Neunteufl, D Christopher Metzger, Roxana Mehran, C Michael Gibson, Gregg W Stone

Research output: Journal article (peer-reviewed)Journal article

15 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1097-1104
Number of pages8
JournalAmerican Journal of Cardiology
Volume118
Issue number8
DOIs
Publication statusPublished - 15 Oct 2016

Keywords

  • Abciximab
  • Age Distribution
  • Aged
  • Anterior Wall Myocardial Infarction/diagnostic imaging
  • Antibodies, Monoclonal/therapeutic use
  • Case-Control Studies
  • Female
  • Humans
  • Hypertension/epidemiology
  • Immunoglobulin Fab Fragments/therapeutic use
  • Injections, Intra-Arterial
  • Kaplan-Meier Estimate
  • Linear Models
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Mortality
  • Multivariate Analysis
  • Myocardial Revascularization/statistics & numerical data
  • Percutaneous Coronary Intervention/methods
  • Platelet Aggregation Inhibitors/therapeutic use
  • Proportional Hazards Models
  • Randomized Controlled Trials as Topic
  • Recurrence
  • ST Elevation Myocardial Infarction/diagnostic imaging
  • Severity of Illness Index
  • Sex Distribution
  • Smoking/epidemiology
  • Stroke/epidemiology
  • Thrombectomy/methods
  • Treatment Outcome

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