Effect of Smoking on Outcomes of Primary PCI in Patients With STEMI

Björn Redfors; Ariel Furer; Harry P. Selker; Holger Thiele; Manesh R. Patel; Shmuel Chen; James E. Udelson; E. Magnus Ohman; Ingo Eitel; Christopher B. Granger; Akiko Maehara; Ajay J. Kirtane; Philippe Généreux; Paul L. Jenkins; Ori Ben-Yehuda; Gregg W. Stone

doi:10.1016/j.jacc.2020.02.045

Effect of Smoking on Outcomes of Primary PCI in Patients With STEMI

Björn Redfors, Ariel Furer, Harry P. Selker, Holger Thiele, Manesh R. Patel, Shmuel Chen, James E. Udelson, E. Magnus Ohman, Ingo Eitel, Christopher B. Granger, Akiko Maehara, Ajay J. Kirtane, Philippe Généreux, Paul L. Jenkins, Ori Ben-Yehuda, Gregg W. Stone^*

^*Corresponding author for this work

Clinic of Internal Medicine II - Cardiology

3 Citations (Scopus)

Abstract

Background: Smoking is a well-established risk factor for ST-segment elevation myocardial infarction (STEMI); however, once STEMI occurs, smoking has been associated with favorable short-term outcomes, an observation termed the “smoker's paradox.” It has been postulated that smoking might exert protective effects that could reduce infarct size, a strong independent predictor of worse outcomes after STEMI. Objectives: The purpose of this study was to determine the relationship among smoking, infarct size, microvascular obstruction (MVO), and adverse outcomes after STEMI. Methods: Individual patient-data were pooled from 10 randomized trials of patients with STEMI undergoing primary percutaneous coronary intervention. Infarct size was assessed at median 4 days by either cardiac magnetic resonance imaging or technetium-99m sestamibi single-photon emission computed tomography. Multivariable analysis was used to assess the relationship between smoking, infarct size, and the 1-year rates of death or heart failure (HF) hospitalization and reinfarction. Results: Among 2,564 patients with STEMI, 1,093 (42.6%) were recent smokers. Smokers were 10 years younger and had fewer comorbidities. Infarct size was similar in smokers and nonsmokers (adjusted difference: 0.0%; 95% confidence interval [CI]: −3.3% to 3.3%; p = 0.99). Nor was the extent of MVO different between smokers and nonsmokers. Smokers had lower crude 1-year rates of all-cause death (1.0% vs. 2.9%; p < 0.001) and death or HF hospitalization (3.3% vs. 5.1%; p = 0.009) with similar rates of reinfarction. After adjustment for age and other risk factors, smokers had a similar 1-year risk of death (adjusted hazard ratio [adjHR]: 0.92; 95% CI: 0.46 to 1.84) and higher risks of death or HF hospitalization (adjHR: 1.49; 95% CI: 1.09 to 2.02) as well as reinfarction (adjHR: 1.97; 95% CI: 1.17 to 3.33). Conclusions: In the present large-scale individual patient-data pooled analysis, recent smoking was unrelated to infarct size or MVO, but was associated with a worse prognosis after primary PCI in STEMI. The smoker's paradox may be explained by the younger age and fewer cardiovascular risk factors in smokers compared with nonsmokers.

Original language	English
Journal	Journal of the American College of Cardiology
Volume	75
Issue number	15
Pages (from-to)	1743-1754
Number of pages	12
ISSN	0735-1097
DOIs	https://doi.org/10.1016/j.jacc.2020.02.045
Publication status	Published - 21.04.2020

Research Areas and Centers

Centers: Cardiological Center Luebeck (UHZL)

DFG Research Classification Scheme

205-12 Cardiology, Angiology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jacc.2020.02.045

Cite this

Redfors, B., Furer, A., Selker, H. P., Thiele, H., Patel, M. R., Chen, S., Udelson, J. E., Ohman, E. M., Eitel, I., Granger, C. B., Maehara, A., Kirtane, A. J., Généreux, P., Jenkins, P. L., Ben-Yehuda, O., & Stone, G. W. (2020). Effect of Smoking on Outcomes of Primary PCI in Patients With STEMI. Journal of the American College of Cardiology, 75(15), 1743-1754. https://doi.org/10.1016/j.jacc.2020.02.045

@article{28369b48ecf2422b8f086e39723cb062,

title = "Effect of Smoking on Outcomes of Primary PCI in Patients With STEMI",

abstract = "Background: Smoking is a well-established risk factor for ST-segment elevation myocardial infarction (STEMI); however, once STEMI occurs, smoking has been associated with favorable short-term outcomes, an observation termed the “smoker's paradox.” It has been postulated that smoking might exert protective effects that could reduce infarct size, a strong independent predictor of worse outcomes after STEMI. Objectives: The purpose of this study was to determine the relationship among smoking, infarct size, microvascular obstruction (MVO), and adverse outcomes after STEMI. Methods: Individual patient-data were pooled from 10 randomized trials of patients with STEMI undergoing primary percutaneous coronary intervention. Infarct size was assessed at median 4 days by either cardiac magnetic resonance imaging or technetium-99m sestamibi single-photon emission computed tomography. Multivariable analysis was used to assess the relationship between smoking, infarct size, and the 1-year rates of death or heart failure (HF) hospitalization and reinfarction. Results: Among 2,564 patients with STEMI, 1,093 (42.6%) were recent smokers. Smokers were 10 years younger and had fewer comorbidities. Infarct size was similar in smokers and nonsmokers (adjusted difference: 0.0%; 95% confidence interval [CI]: −3.3% to 3.3%; p = 0.99). Nor was the extent of MVO different between smokers and nonsmokers. Smokers had lower crude 1-year rates of all-cause death (1.0% vs. 2.9%; p < 0.001) and death or HF hospitalization (3.3% vs. 5.1%; p = 0.009) with similar rates of reinfarction. After adjustment for age and other risk factors, smokers had a similar 1-year risk of death (adjusted hazard ratio [adjHR]: 0.92; 95% CI: 0.46 to 1.84) and higher risks of death or HF hospitalization (adjHR: 1.49; 95% CI: 1.09 to 2.02) as well as reinfarction (adjHR: 1.97; 95% CI: 1.17 to 3.33). Conclusions: In the present large-scale individual patient-data pooled analysis, recent smoking was unrelated to infarct size or MVO, but was associated with a worse prognosis after primary PCI in STEMI. The smoker's paradox may be explained by the younger age and fewer cardiovascular risk factors in smokers compared with nonsmokers.",

author = "Bj{\"o}rn Redfors and Ariel Furer and Selker, {Harry P.} and Holger Thiele and Patel, {Manesh R.} and Shmuel Chen and Udelson, {James E.} and Ohman, {E. Magnus} and Ingo Eitel and Granger, {Christopher B.} and Akiko Maehara and Kirtane, {Ajay J.} and Philippe G{\'e}n{\'e}reux and Jenkins, {Paul L.} and Ori Ben-Yehuda and Stone, {Gregg W.}",

note = "Funding Information: Dr. Patel has received grants from Bayer, Janssen, HeartFlow, and the National Heart, Lung, and Blood Institute; and has served as an advisor/consultant for AstraZeneca, Bayer, Janssen, and HeartFlow. Dr. Udelson has served on a trial steering committee for Abiomed; and has served as a consultant for Imbria Pharmaceuticals. Dr. Ohman has received research grants from Abiomed, Chiesi, and Portola; and has served as a consultant for Abiomed, Cara Therapeutics, Genentech, Imbria Pharmaceuticals, Impulse Dynamics, Janssen Pharmaceuticals, Medtronic, Medscape, Milestone Pharmaceuticals, and XyloCor Therapeutics. Dr. Granger has received research grants from AstraZeneca, the U.S. Food and Drug Administration, National Institutes of Health, GlaxoSmithKline, Medtronic, Novartis, Apple, Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, and Janssen; has served as a consultant for AstraZeneca, Espero, GlaxoSmithKline, Medtronic, Novartis, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb/Pfizer, Daiichi-Sankyo, Merck, Roche, Eli Lilly, The Medicines Company, and Janssen. Dr. Maehara has received grant support from and served as a consultant for Abbott Vascular and Boston Scientific; and has served as a consultant for Conavi Medical Inc. Dr. Kirtane has received institutional funding to Columbia University and/or Cardiovascular Research Foundation from Medtronic, Boston Scientific, Abbott Vascular, Abiomed, CSI, CathWorks, Siemens, Philips, and ReCor Medical. Dr, G?n?reux has received speaker fees from Abbott Vascular, Edwards Lifesciences, Medtronic, Tryton Medical Inc., Cardinal Health, and Cardiovascular Systems Inc.; has received consulting fees from Abbott Vascular, Boston Scientific, Cardiovascular Systems Inc., and Pi-Cardia; has received an institutional research grant from Boston Scientific; and has equity in SIG.NUM, SoundBite Medical Solutions Inc., Saranas, and Pi-Cardia. Dr. Stone has served as a consultant to Miracor, TherOx, and Abiomed. All other authors have reported that they have no relationships relevant to the contents of this paper. Harvey D. White, DSC, FACC, served as Guest Associate Editor for this paper. Publisher Copyright: {\textcopyright} 2020 American College of Cardiology Foundation Copyright: Copyright 2020 Elsevier B.V., All rights reserved.",

year = "2020",

month = apr,

day = "21",

doi = "10.1016/j.jacc.2020.02.045",

language = "English",

volume = "75",

pages = "1743--1754",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

number = "15",

}

Redfors, B, Furer, A, Selker, HP, Thiele, H, Patel, MR, Chen, S, Udelson, JE, Ohman, EM, Eitel, I, Granger, CB, Maehara, A, Kirtane, AJ, Généreux, P, Jenkins, PL, Ben-Yehuda, O & Stone, GW 2020, 'Effect of Smoking on Outcomes of Primary PCI in Patients With STEMI', Journal of the American College of Cardiology, vol. 75, no. 15, pp. 1743-1754. https://doi.org/10.1016/j.jacc.2020.02.045

TY - JOUR

T1 - Effect of Smoking on Outcomes of Primary PCI in Patients With STEMI

AU - Redfors, Björn

AU - Furer, Ariel

AU - Selker, Harry P.

AU - Thiele, Holger

AU - Patel, Manesh R.

AU - Chen, Shmuel

AU - Udelson, James E.

AU - Ohman, E. Magnus

AU - Eitel, Ingo

AU - Granger, Christopher B.

AU - Maehara, Akiko

AU - Kirtane, Ajay J.

AU - Généreux, Philippe

AU - Jenkins, Paul L.

AU - Ben-Yehuda, Ori

AU - Stone, Gregg W.

N1 - Funding Information: Dr. Patel has received grants from Bayer, Janssen, HeartFlow, and the National Heart, Lung, and Blood Institute; and has served as an advisor/consultant for AstraZeneca, Bayer, Janssen, and HeartFlow. Dr. Udelson has served on a trial steering committee for Abiomed; and has served as a consultant for Imbria Pharmaceuticals. Dr. Ohman has received research grants from Abiomed, Chiesi, and Portola; and has served as a consultant for Abiomed, Cara Therapeutics, Genentech, Imbria Pharmaceuticals, Impulse Dynamics, Janssen Pharmaceuticals, Medtronic, Medscape, Milestone Pharmaceuticals, and XyloCor Therapeutics. Dr. Granger has received research grants from AstraZeneca, the U.S. Food and Drug Administration, National Institutes of Health, GlaxoSmithKline, Medtronic, Novartis, Apple, Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, and Janssen; has served as a consultant for AstraZeneca, Espero, GlaxoSmithKline, Medtronic, Novartis, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb/Pfizer, Daiichi-Sankyo, Merck, Roche, Eli Lilly, The Medicines Company, and Janssen. Dr. Maehara has received grant support from and served as a consultant for Abbott Vascular and Boston Scientific; and has served as a consultant for Conavi Medical Inc. Dr. Kirtane has received institutional funding to Columbia University and/or Cardiovascular Research Foundation from Medtronic, Boston Scientific, Abbott Vascular, Abiomed, CSI, CathWorks, Siemens, Philips, and ReCor Medical. Dr, G?n?reux has received speaker fees from Abbott Vascular, Edwards Lifesciences, Medtronic, Tryton Medical Inc., Cardinal Health, and Cardiovascular Systems Inc.; has received consulting fees from Abbott Vascular, Boston Scientific, Cardiovascular Systems Inc., and Pi-Cardia; has received an institutional research grant from Boston Scientific; and has equity in SIG.NUM, SoundBite Medical Solutions Inc., Saranas, and Pi-Cardia. Dr. Stone has served as a consultant to Miracor, TherOx, and Abiomed. All other authors have reported that they have no relationships relevant to the contents of this paper. Harvey D. White, DSC, FACC, served as Guest Associate Editor for this paper. Publisher Copyright: © 2020 American College of Cardiology Foundation Copyright: Copyright 2020 Elsevier B.V., All rights reserved.

PY - 2020/4/21

Y1 - 2020/4/21

N2 - Background: Smoking is a well-established risk factor for ST-segment elevation myocardial infarction (STEMI); however, once STEMI occurs, smoking has been associated with favorable short-term outcomes, an observation termed the “smoker's paradox.” It has been postulated that smoking might exert protective effects that could reduce infarct size, a strong independent predictor of worse outcomes after STEMI. Objectives: The purpose of this study was to determine the relationship among smoking, infarct size, microvascular obstruction (MVO), and adverse outcomes after STEMI. Methods: Individual patient-data were pooled from 10 randomized trials of patients with STEMI undergoing primary percutaneous coronary intervention. Infarct size was assessed at median 4 days by either cardiac magnetic resonance imaging or technetium-99m sestamibi single-photon emission computed tomography. Multivariable analysis was used to assess the relationship between smoking, infarct size, and the 1-year rates of death or heart failure (HF) hospitalization and reinfarction. Results: Among 2,564 patients with STEMI, 1,093 (42.6%) were recent smokers. Smokers were 10 years younger and had fewer comorbidities. Infarct size was similar in smokers and nonsmokers (adjusted difference: 0.0%; 95% confidence interval [CI]: −3.3% to 3.3%; p = 0.99). Nor was the extent of MVO different between smokers and nonsmokers. Smokers had lower crude 1-year rates of all-cause death (1.0% vs. 2.9%; p < 0.001) and death or HF hospitalization (3.3% vs. 5.1%; p = 0.009) with similar rates of reinfarction. After adjustment for age and other risk factors, smokers had a similar 1-year risk of death (adjusted hazard ratio [adjHR]: 0.92; 95% CI: 0.46 to 1.84) and higher risks of death or HF hospitalization (adjHR: 1.49; 95% CI: 1.09 to 2.02) as well as reinfarction (adjHR: 1.97; 95% CI: 1.17 to 3.33). Conclusions: In the present large-scale individual patient-data pooled analysis, recent smoking was unrelated to infarct size or MVO, but was associated with a worse prognosis after primary PCI in STEMI. The smoker's paradox may be explained by the younger age and fewer cardiovascular risk factors in smokers compared with nonsmokers.

AB - Background: Smoking is a well-established risk factor for ST-segment elevation myocardial infarction (STEMI); however, once STEMI occurs, smoking has been associated with favorable short-term outcomes, an observation termed the “smoker's paradox.” It has been postulated that smoking might exert protective effects that could reduce infarct size, a strong independent predictor of worse outcomes after STEMI. Objectives: The purpose of this study was to determine the relationship among smoking, infarct size, microvascular obstruction (MVO), and adverse outcomes after STEMI. Methods: Individual patient-data were pooled from 10 randomized trials of patients with STEMI undergoing primary percutaneous coronary intervention. Infarct size was assessed at median 4 days by either cardiac magnetic resonance imaging or technetium-99m sestamibi single-photon emission computed tomography. Multivariable analysis was used to assess the relationship between smoking, infarct size, and the 1-year rates of death or heart failure (HF) hospitalization and reinfarction. Results: Among 2,564 patients with STEMI, 1,093 (42.6%) were recent smokers. Smokers were 10 years younger and had fewer comorbidities. Infarct size was similar in smokers and nonsmokers (adjusted difference: 0.0%; 95% confidence interval [CI]: −3.3% to 3.3%; p = 0.99). Nor was the extent of MVO different between smokers and nonsmokers. Smokers had lower crude 1-year rates of all-cause death (1.0% vs. 2.9%; p < 0.001) and death or HF hospitalization (3.3% vs. 5.1%; p = 0.009) with similar rates of reinfarction. After adjustment for age and other risk factors, smokers had a similar 1-year risk of death (adjusted hazard ratio [adjHR]: 0.92; 95% CI: 0.46 to 1.84) and higher risks of death or HF hospitalization (adjHR: 1.49; 95% CI: 1.09 to 2.02) as well as reinfarction (adjHR: 1.97; 95% CI: 1.17 to 3.33). Conclusions: In the present large-scale individual patient-data pooled analysis, recent smoking was unrelated to infarct size or MVO, but was associated with a worse prognosis after primary PCI in STEMI. The smoker's paradox may be explained by the younger age and fewer cardiovascular risk factors in smokers compared with nonsmokers.

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DO - 10.1016/j.jacc.2020.02.045

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AN - SCOPUS:85082840441

SN - 0735-1097

VL - 75

SP - 1743

EP - 1754

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 15

ER -

Effect of Smoking on Outcomes of Primary PCI in Patients With STEMI

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