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European Heart Journal 2001 22(9):776-784; doi:10.1053/euhj.2000.2315
Copyright © 2001 by the European Society of Cardiology.
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In-hospital mortality of habitual cigarette smokers after acute myocardial infarction. The ‘smoker’s paradox' in a countrywide study

G.K Andrikopoulosa,f1, D.J Richtera, P.E Dilaverisa, A Pipilisb, A Zaharoulisc, J.E Gialafosa, P.K Toutouzasd and E.T Chimonase

a State Cardiac Department, Hippokration Hospital, Athens, Greece
b Cardiac Department, Ygeia Hospital, Athens, Greece
c Cardiac Department, Georgios Gennimatas Hospital, Athens, Greece
d Department of Cardiology, University of Athens Medical School, Athens, Greece
e Hellenic Society of Cardiology, 251 Airforce General Hospital, Athens, Greece

revised June 26, 2000; accepted June 28, 2000

Abstract

Aims Habitual cigarette smokers, paradoxically, present improved short-term prognosis after acute myocardial infarction, a phenomenon often termed ‘smoker’s paradox'. We sought to examine cigarette smokers' post-infarction survival advantage in a countrywide survey of unselected, consecutive patients presenting with acute myocardial infarction.

Methods and Results The study population was derived from the registry of the Hellenic study of acute myocardial infarction, which recruited 7433 consecutive patients with acute myocardial infarction from 76, out of a total of 86, hospitals countrywide. Cigarette smokers presented with lower unadjusted mortality rates (7·4% vs 14·5%, P<0·001), were younger, predominantly of male gender and were less likely to suffer from diabetes mellitus and arterial hypertension. When all univariate predictors of poor outcome were included as covariates in multivariate analysis, smoking status was not significantly associated with inhospital mortality (relative risk=1·12, 95% CI=0·86–1·44, P=0·399). The beneficial effect of thrombolytic therapy was independent of the smoking status in both univariate and multivariate analysis.

Conclusion Unadjusted mortality rates are significantly lower in smokers, but age accounted for much of their seemingly improved outcome. When a number of additional clinical variables were taken into consideration, no significant influence of habitual smoking on early outcome following acute myocardial infarction was observed.

Key Words: Acute myocardial infarction, prognosis, cigarette smoking

f1 Correspondence: George K. Andrikopoulos, MD, 9 Yrkanias str., 11142 Athens, Greece.

References

  1. Scott CW, Bernstein SL, Coble YD. The Wordwide Smoking Epidemic: Council Reports. JAMA. 1990;24:3312–3318
  2. Bartecci CE, Mackenzie TD, Schrier RW. The human costs of tobacco use. N Engl J Med. 1994;330:907–912[Free Full Text]
  3. Wood D, Backer G, Faergeman O, Graham I, Mancia G, Pyörälä K. Prevention of coronary heart disease in clinical practice. Recommendations of the second joint task force of European and other societies on coronary prevention. Eur Heart J. 1998;19:1434–1503[Free Full Text]
  4. Grundy SM, Pasternak R, Greenland P, Smith S, Fuster V. Assessment of cardiovascular risk by use of multiple-risk-factor assessment equations. A statement for healthcare professionals from the AHA/ACC. Circulation. 1999;100:1481–1492[Free Full Text]
  5. Sparrow D, Dawber TR. The influence of cigarette smoking on prognosis after a first myocardial infarction. A report from the Framingham Study. J Chron Dis. 1977;31:425–432
  6. Kelly TL, Gilpin E, Ahnve S, Henning H, Ross J. Smoking status at the time of acute myocardial infarction and subsequent prognosis. Am Heart J. 1985;110:535–541[CrossRef][Web of Science][Medline]
  7. Grines CL, Topol EJ, O'Neil WW. Effect of cigarette smoking on outcome after thrombolytic therapy for myocardial infarction. Circulation. 1995;91:298–303[Abstract/Free Full Text]
  8. Barbash GI, White HD, Modan M. Significance of smoking in patients receiving thrombolytic therapy for acute myocardial infarction. Experience gleaned from the International Tissue Plasminogen Activator/Streptocinase Mortality Trial. Circulation. 1993;87:53–58[Abstract/Free Full Text]
  9. Gomez MA, Karagounis LA, Allen A, Anderson JL. Effect of cigarette smoking on coronary patency after thrombolytic therapy for myocardial infarction. Am J Cardiol. 1993;72:373–378[CrossRef][Web of Science][Medline]
  10. Barbash GI, Reiner J, Harvey W. Evaluation of paradoxical beneficial effects of smoking in patients receiving thrombolytic therapy for acute myocardial infarction: Mechanism of the Smoker's Paradox from the GUSTO-I trial, with angiographic insights. J Am Coll Cardiol. 1995;26:1222–1229[Abstract]
  11. Lee KL, Woodlief LH, Topol EJ. Predictors of 30-day mortality in the era of reperfusion for acute myocardial infarction. Circulation. 1995;91:1659–1668[Abstract/Free Full Text]
  12. De Chillou C, Riff P, Sadoul N. Influence of cigarette smoking on rate of reopening of the infarct-related coronary artery after myocardial infarction: a multivariate analysis. J Am Coll Cardiol. 1996;27:1662–1668[Abstract]
  13. Ishihara M, Sato H, Tateishi H. Clinical implications of cigarette smoking in acute myocardial infarction: Acute angiographic findings and long-term prognosis. Am Heart J. 1997;134:955–960[CrossRef][Web of Science][Medline]
  14. Gottlieb S, Boyko V, Zahger D. Smoking and prognosis after acute myocardial infarction in the thrombolytic era. J Am Coll Cardiol. 1996;28:1506–1513[Abstract]
  15. Mueller HS, Cohen LS, Braunwald E. Predictors of early morbidity and mortality after thrombolytic therapy of acute myocardial infarction. Analysis of patient subgroups in the Thrombolysis In Myocardial Infarction (TIMI) trial, phase II. Circulation. 1992;85:1254–1264[Abstract/Free Full Text]
  16. Hasdai D, Lerman A, Rihal C. Smoking status and outcome after primary coronary angioplasty for acute myocardial infarction. Am Heart J. 1999;137:612–620[CrossRef][Web of Science][Medline]
  17. Gunnar RM, Bourdillon PD, Dixon DW. ACC/AHA guidelines for the early management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures. Circulation. 1990;82:664–707[Free Full Text]
  18. Vlietstra RE, Kronmal RA, Frye RL, Seth AK, Tristani FE, Killip T. Factors affecting the extent and severity of coronary artery disease in patients enrolled in the Coronary Artery Surgery Study. Atherosclerosis. 1982;2:208–215
  19. Hasdai D, Rihal CS, Lerman A, Grill DE, Holmes DR. Smokers undergoing percutaneous coronary revascularisation present with fewer narrowings in the target coronary artery. Am J Cardiol. 1997;80:1212–1214[CrossRef][Web of Science][Medline]
  20. Kimura S, Nishinaga M, Ozawa T, Shimada K. Thrombin generation as an acute effect of cigarette smoking. Am Heart J. 1994;128:7–11[CrossRef][Web of Science][Medline]
  21. Hung J, Lam JY, Lacoste L, Letchacovski G. Cigarette smoking acutely increases platelet thrombus formation in patients with coronary artery disease taking aspirin. Circulation. 1995;92:2432–2436[Abstract/Free Full Text]
  22. Fitzgerald GA, Oates JA, Nowak J. Cigarette smoking and haemostatic function. Am Heart J. 1988;115:267–271[CrossRef][Web of Science][Medline]
  23. Newby DE, Wright RA, Labinjoh C. Endothelium dysfunction, impaired endogenous fibrinolysis and cigarette smoking. Circulation. 1999;99:1411–1415[Abstract/Free Full Text]
  24. Greenland P, Reicher-Reiss H, Goldbourt U, Behar S. In-hospital and one-year mortality in 1254 women after myocardial infarction-comparison with 4315 men. Circulation. 1991;83:484–491[Abstract/Free Full Text]
  25. Vaccarino V, Parsons L, Every NR, Barron HV, Krumholz HM. Sex-based differences in early mortality after myocardial infarction. N Engl J Med. 1999;341:217–225[Abstract/Free Full Text]
  26. Himonas E, Andrikopoulos G, Richter D. Acute myocardial infarction in women. Epidemiologic variables from a low risk Mediterranean population (Abstr). J Am Coll Cardiol. 1999;33:148A
  27. Molstad P. First myocardial infarction in smokers. Eur Heart J. 1993;12:753–759
  28. Hansson PO, Eriksson H, Welin L, Svardsudd K, Wilhelmsen L. Smoking and abdominal obesity: risk factors for venous thromboembolism among middle-aged men: the study of men born in 1913. Arch Intern Med. 1999;159:1886–1890[Abstract/Free Full Text]
  29. Celermaier DS, Sorensen KE, Georgakopoulos D. Cigarette smoking is associated with dose-related and potentially reversible impairment of endothelium-dependent dilatation in healthy young subjects. Circulation. 1993;88:2149–2155[Abstract/Free Full Text]
  30. Migliacci R, Gresele P. Smoking and impaired endothelium dependent dilatation. N Engl J Med. 1996;334:1674[Free Full Text]
  31. Benowitz NL. Pharmacologic aspects of cigarette smoking and nicotine addiction. N Engl J Med. 1988;319:1318–1328[Web of Science][Medline]
  32. Bounameaux H, Griessen M, Benedet P. Nicotine induced haemodynamic changes during cigarette smoking and nicotine gum chewing: a placebo control study in young healthy volunteers. Cardiovasc Res. 1988;22:154–158[Web of Science][Medline]
  33. Luchini D, Bertocchi F, Maliani A. A controlled study of the autonomic changes produced by habitual cigarette smoking in healthy subjects. Cardiovasc Res. 1996;31:633–639[CrossRef][Web of Science][Medline]
  34. Niedermaier ON, Smith ML, Beightol LA. Influence of Cigarette Smoking on Human Autonomic Function. Circulation. 1993;88:562–571[Abstract/Free Full Text]
  35. Lewis RP, Boudoulas H. Catecholamines, cigarette smoking, arrhythmias and acute myocardial infarction. Am Heart J. 1974;88:526–528[CrossRef][Web of Science][Medline]
  36. Peters RW, Brooks MM, Todd L, Liesbon PR, Wilhelmsen L. Smoking cessation and arrhythmic death. J Am Coll Cardiol. 1995;26:1287–1292[Abstract]

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