Smoker's paradox in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Tanush Gupta, Dhaval Kolte, Sahil Khera, Prakash Harikrishnan, Marjan Mujib, Wilbert S. Aronow, Diwakar Jain, Ali Ahmed, Howard A. Cooper, William H. Frishman, Deepak L. Bhatt, Gregg C. Fonarow, Julio A. Panza

Research output: Contribution to journalArticle

Abstract

Background-Prior studies have found that smokers undergoing thrombolytic therapy for ST-segment elevation myocardial infarction have lower in-hospital mortality than nonsmokers, a phenomenon called the "smoker's paradox." Evidence, however, has been conflicting regarding whether this paradoxical association persists in the era of primary percutaneous coronary intervention. Methods and Results-We used the 2003-2012 National Inpatient Sample databases to identify all patients aged ≥18 years who underwent primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Multivariable logistic regression was used to compare in-hospital mortality between smokers (current and former) and nonsmokers. Of the 985 174 patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention, 438 954 (44.6%) were smokers. Smokers were younger, were more often men, and were less likely to have traditional vascular risk factors than nonsmokers. Smokers had lower observed in-hospital mortality compared with nonsmokers (2.0% versus 5.9%; unadjusted odds ratio 0.32, 95% CI 0.31-0.33, P<0.001). Although the association between smoking and lower in-hospital mortality was partly attenuated after baseline risk adjustment, a significant residual association remained (adjusted odds ratio 0.60, 95% CI 0.58-0.62, P<0.001). This association largely persisted in age-stratified analyses. Smoking status was also associated with shorter average length of stay (3.5 versus 4.5 days, P<0.001) and lower incidence of postprocedure hemorrhage (4.2% versus 6.1%; adjusted odds ratio 0.81, 95% CI 0.80-0.83, P<0.001) and in-hospital cardiac arrest (1.3% versus 2.1%; adjusted OR 0.78, 95% CI 0.76-0.81, P<0.001). Conclusions-In this nationwide cohort of patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction, we observed significantly lower risk-adjusted in-hospital mortality in smokers, suggesting that the smoker's paradox also applies to ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.

Original languageEnglish (US)
Article numbere003370
JournalJournal of the American Heart Association
Volume5
Issue number4
DOIs
StatePublished - Jan 1 2016

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Percutaneous Coronary Intervention
Hospital Mortality
Odds Ratio
Smoking
Risk Adjustment
Thrombolytic Therapy
Heart Arrest
Inpatients
Length of Stay
Logistic Models
ST Elevation Myocardial Infarction
Databases
Hemorrhage
Incidence

Keywords

  • Primary percutaneous coronary intervention
  • ST-segment elevation myocardial infarction
  • Smoker's paradox
  • Smoking

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Smoker's paradox in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. / Gupta, Tanush; Kolte, Dhaval; Khera, Sahil; Harikrishnan, Prakash; Mujib, Marjan; Aronow, Wilbert S.; Jain, Diwakar; Ahmed, Ali; Cooper, Howard A.; Frishman, William H.; Bhatt, Deepak L.; Fonarow, Gregg C.; Panza, Julio A.

In: Journal of the American Heart Association, Vol. 5, No. 4, e003370, 01.01.2016.

Research output: Contribution to journalArticle

Gupta, T, Kolte, D, Khera, S, Harikrishnan, P, Mujib, M, Aronow, WS, Jain, D, Ahmed, A, Cooper, HA, Frishman, WH, Bhatt, DL, Fonarow, GC & Panza, JA 2016, 'Smoker's paradox in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention', Journal of the American Heart Association, vol. 5, no. 4, e003370. https://doi.org/10.1161/JAHA.116.003370
Gupta, Tanush ; Kolte, Dhaval ; Khera, Sahil ; Harikrishnan, Prakash ; Mujib, Marjan ; Aronow, Wilbert S. ; Jain, Diwakar ; Ahmed, Ali ; Cooper, Howard A. ; Frishman, William H. ; Bhatt, Deepak L. ; Fonarow, Gregg C. ; Panza, Julio A. / Smoker's paradox in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. In: Journal of the American Heart Association. 2016 ; Vol. 5, No. 4.
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abstract = "Background-Prior studies have found that smokers undergoing thrombolytic therapy for ST-segment elevation myocardial infarction have lower in-hospital mortality than nonsmokers, a phenomenon called the {"}smoker's paradox.{"} Evidence, however, has been conflicting regarding whether this paradoxical association persists in the era of primary percutaneous coronary intervention. Methods and Results-We used the 2003-2012 National Inpatient Sample databases to identify all patients aged ≥18 years who underwent primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Multivariable logistic regression was used to compare in-hospital mortality between smokers (current and former) and nonsmokers. Of the 985 174 patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention, 438 954 (44.6{\%}) were smokers. Smokers were younger, were more often men, and were less likely to have traditional vascular risk factors than nonsmokers. Smokers had lower observed in-hospital mortality compared with nonsmokers (2.0{\%} versus 5.9{\%}; unadjusted odds ratio 0.32, 95{\%} CI 0.31-0.33, P<0.001). Although the association between smoking and lower in-hospital mortality was partly attenuated after baseline risk adjustment, a significant residual association remained (adjusted odds ratio 0.60, 95{\%} CI 0.58-0.62, P<0.001). This association largely persisted in age-stratified analyses. Smoking status was also associated with shorter average length of stay (3.5 versus 4.5 days, P<0.001) and lower incidence of postprocedure hemorrhage (4.2{\%} versus 6.1{\%}; adjusted odds ratio 0.81, 95{\%} CI 0.80-0.83, P<0.001) and in-hospital cardiac arrest (1.3{\%} versus 2.1{\%}; adjusted OR 0.78, 95{\%} CI 0.76-0.81, P<0.001). Conclusions-In this nationwide cohort of patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction, we observed significantly lower risk-adjusted in-hospital mortality in smokers, suggesting that the smoker's paradox also applies to ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.",
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T1 - Smoker's paradox in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

AU - Gupta, Tanush

AU - Kolte, Dhaval

AU - Khera, Sahil

AU - Harikrishnan, Prakash

AU - Mujib, Marjan

AU - Aronow, Wilbert S.

AU - Jain, Diwakar

AU - Ahmed, Ali

AU - Cooper, Howard A.

AU - Frishman, William H.

AU - Bhatt, Deepak L.

AU - Fonarow, Gregg C.

AU - Panza, Julio A.

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Background-Prior studies have found that smokers undergoing thrombolytic therapy for ST-segment elevation myocardial infarction have lower in-hospital mortality than nonsmokers, a phenomenon called the "smoker's paradox." Evidence, however, has been conflicting regarding whether this paradoxical association persists in the era of primary percutaneous coronary intervention. Methods and Results-We used the 2003-2012 National Inpatient Sample databases to identify all patients aged ≥18 years who underwent primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Multivariable logistic regression was used to compare in-hospital mortality between smokers (current and former) and nonsmokers. Of the 985 174 patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention, 438 954 (44.6%) were smokers. Smokers were younger, were more often men, and were less likely to have traditional vascular risk factors than nonsmokers. Smokers had lower observed in-hospital mortality compared with nonsmokers (2.0% versus 5.9%; unadjusted odds ratio 0.32, 95% CI 0.31-0.33, P<0.001). Although the association between smoking and lower in-hospital mortality was partly attenuated after baseline risk adjustment, a significant residual association remained (adjusted odds ratio 0.60, 95% CI 0.58-0.62, P<0.001). This association largely persisted in age-stratified analyses. Smoking status was also associated with shorter average length of stay (3.5 versus 4.5 days, P<0.001) and lower incidence of postprocedure hemorrhage (4.2% versus 6.1%; adjusted odds ratio 0.81, 95% CI 0.80-0.83, P<0.001) and in-hospital cardiac arrest (1.3% versus 2.1%; adjusted OR 0.78, 95% CI 0.76-0.81, P<0.001). Conclusions-In this nationwide cohort of patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction, we observed significantly lower risk-adjusted in-hospital mortality in smokers, suggesting that the smoker's paradox also applies to ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.

AB - Background-Prior studies have found that smokers undergoing thrombolytic therapy for ST-segment elevation myocardial infarction have lower in-hospital mortality than nonsmokers, a phenomenon called the "smoker's paradox." Evidence, however, has been conflicting regarding whether this paradoxical association persists in the era of primary percutaneous coronary intervention. Methods and Results-We used the 2003-2012 National Inpatient Sample databases to identify all patients aged ≥18 years who underwent primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Multivariable logistic regression was used to compare in-hospital mortality between smokers (current and former) and nonsmokers. Of the 985 174 patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention, 438 954 (44.6%) were smokers. Smokers were younger, were more often men, and were less likely to have traditional vascular risk factors than nonsmokers. Smokers had lower observed in-hospital mortality compared with nonsmokers (2.0% versus 5.9%; unadjusted odds ratio 0.32, 95% CI 0.31-0.33, P<0.001). Although the association between smoking and lower in-hospital mortality was partly attenuated after baseline risk adjustment, a significant residual association remained (adjusted odds ratio 0.60, 95% CI 0.58-0.62, P<0.001). This association largely persisted in age-stratified analyses. Smoking status was also associated with shorter average length of stay (3.5 versus 4.5 days, P<0.001) and lower incidence of postprocedure hemorrhage (4.2% versus 6.1%; adjusted odds ratio 0.81, 95% CI 0.80-0.83, P<0.001) and in-hospital cardiac arrest (1.3% versus 2.1%; adjusted OR 0.78, 95% CI 0.76-0.81, P<0.001). Conclusions-In this nationwide cohort of patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction, we observed significantly lower risk-adjusted in-hospital mortality in smokers, suggesting that the smoker's paradox also applies to ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.

KW - Primary percutaneous coronary intervention

KW - ST-segment elevation myocardial infarction

KW - Smoker's paradox

KW - Smoking

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