Impact of smoking on in hospital mortality of patients older than 60 with STEMI treated with Primary Percutaneous Coronary Intervention

Abstract

Several studies have shown a 'smoker's paradox', where following an acute myocardial infarction, smokers have a paradoxically lower mortality than non-smokers. Evidence, however, has been conflicting regarding whether this paradoxical association persists in the era of primary percutaneous coronary intervention. This study examined the presence or absence of smoking paradox in people over 60 years of age who underwent primary angioplasty.

Methods: This retrospective study included all patients admitted with acute STEMI undergoing primary PCI in Madani Heart center from 2014 to 2018. The survival status for all patients post- STEMI was obtained. Multivariable logistic regression was used to compare in-hospital mortality between smokers and non-smokers. Differences in survival by smoking status were assessed using a Kaplan-Meier curve, and after adjustment for age, gender, and additional cardiovascular risk factors using a T-Test analysis.

Results: The 1-year mortality for patients with STEMI was 9 (3.8%). Of the 234 patients with ST- segment elevation myocardial infarction undergoing primary percutaneous coronary intervention, 130 (55.5%) were smokers. Smokers were non-significantly younger, were more often men, and were less likely to have traditional vascular risk factors than nonsmokers. Smokers had no difference in in-hospital and one-year mortality compared with nonsmokers. A multivariate analyzing model found no evidence of an association between mortality and smoking status after adjustment; p=0.81. There was no significant difference between the two groups in any of MACE complications either hospitalization or one year later.