TY - JOUR
T1 - “Smoker's paradox” in patients with cardiogenic shock complicating myocardial infarction - A substudy of the IABP-SHOCK II-trial and registry
AU - Saad, Mohammed
AU - Fuernau, Georg
AU - Desch, Steffen
AU - Eitel, Ingo
AU - Jung, Christian
AU - Pöss, Janine
AU - Schneider, Steffen
AU - Schuler, Gerhard
AU - Werdan, Karl
AU - Zeymer, Uwe
AU - Thiele, Holger
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Background Several studies in patients with acute myocardial infarction (AMI) without cardiogenic shock (CS) indicate a better survival in smokers, the so called “smoker's paradox”. For CS, this relationship has not been investigated so far in the primary percutaneous coronary intervention (PCI) era. Methods In a predefined substudy of the Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial and its accompanying registry including patients with CS complicating AMI we investigated differences in outcome of smokers compared to non-smokers. All-cause-mortality at 1 year was used as primary endpoint. Results Of 772 patients with available smoking status 263 patients were smokers (34%). Smokers were more often male (79% vs. 65%; p < 0.001), of younger age (61 [interquartile range IQR 52–70] vs. 73 [IQR 64–79] years; p < 0.001), had less comorbidity including arterial hypertension (62% vs. 71%; p = 0.007) and diabetes mellitus (26% vs. 38%; p < 0.001) and had lower levels of serum creatinine (13% vs. 25%; p < 0.001). There was no significant difference between the 2 groups regarding left ventricular ejection fraction, initial revascularization strategy or use of IABP. Smokers had lower rates of mortality at 12 months in univariable analysis (43% vs. 59%; p < 0.001) but not after adjustment for important confounders using Cox-regression analysis (hazard ratio 0.77, 95% confidence interval 0.59–1.03; p = 0.08). Conclusion Smoking is not predictive of outcome in patients with CS complicating AMI. The observed survival benefit in univariable analysis seems to be explained by the younger age and lower risk profile of smokers.
AB - Background Several studies in patients with acute myocardial infarction (AMI) without cardiogenic shock (CS) indicate a better survival in smokers, the so called “smoker's paradox”. For CS, this relationship has not been investigated so far in the primary percutaneous coronary intervention (PCI) era. Methods In a predefined substudy of the Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial and its accompanying registry including patients with CS complicating AMI we investigated differences in outcome of smokers compared to non-smokers. All-cause-mortality at 1 year was used as primary endpoint. Results Of 772 patients with available smoking status 263 patients were smokers (34%). Smokers were more often male (79% vs. 65%; p < 0.001), of younger age (61 [interquartile range IQR 52–70] vs. 73 [IQR 64–79] years; p < 0.001), had less comorbidity including arterial hypertension (62% vs. 71%; p = 0.007) and diabetes mellitus (26% vs. 38%; p < 0.001) and had lower levels of serum creatinine (13% vs. 25%; p < 0.001). There was no significant difference between the 2 groups regarding left ventricular ejection fraction, initial revascularization strategy or use of IABP. Smokers had lower rates of mortality at 12 months in univariable analysis (43% vs. 59%; p < 0.001) but not after adjustment for important confounders using Cox-regression analysis (hazard ratio 0.77, 95% confidence interval 0.59–1.03; p = 0.08). Conclusion Smoking is not predictive of outcome in patients with CS complicating AMI. The observed survival benefit in univariable analysis seems to be explained by the younger age and lower risk profile of smokers.
UR - http://www.scopus.com/inward/record.url?scp=84981333816&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2016.07.172
DO - 10.1016/j.ijcard.2016.07.172
M3 - Journal articles
C2 - 27521557
AN - SCOPUS:84981333816
SN - 0167-5273
VL - 222
SP - 775
EP - 779
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -