Journal
AMERICAN JOURNAL OF CARDIOLOGY
Volume 118, Issue 8, Pages 1097-1104Publisher
EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
DOI: 10.1016/j.amjcard.2016.07.019
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Categories
Funding
- Boston Scientific
- Medtronic
- Abbott Vascular
- Abiomed
- St. Jude Medical
- Vascular Dynamics
- Eli Lilly
- Edwards Lifescience
- Cardiovascular Systems Inc.
- PiCardia
- AstraZeneca
- Atrium Medical Corporation
- Bayer
- Boehringer Ingelheim
- Biosensors International
- Biotronik
- BMS/Sanofi-Aventis
- Edwards Lifesciences
- Daiichi Sankyo
- Magnet
- Menarini
- St. Jude
- Medicines Company
- DSI
- OrbusNeich
- CSL Behring
- Janssen Pharmaceuticals Inc.
- Merck Co.
- Osprey Medical Inc.
- Watermark Research Partners
- Angel Medical Corporation
- Atrium Medical Systems
- Bristol Meyers
- Squibb Company
- Ikaria, Inc.
- Janssen Pharmaceuticals
- Johnson & Johnson Corporation
- Lantheus Medical Imaging
- Medtronic Vascular, Inc.
- Portola Pharmaceuticals
- Stealth Peptides, Inc.
- Volcano Corp
- Walk Vascular
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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 multi variable 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. (C) 2016 Elsevier Inc. All rights reserved.
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