Relation of Smoking Status to Outcomes After Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest

Gupta, Tanush; Kolte, Dhaval; Khera, Sahil; Aronow, Wilbert S.; Palaniswamy, Chandrasekar; Mujib, Marjan; Jain, Diwakar; Sule, Sachin; Ahmed, Ali; Iwai, Sei; Eugenio, Paul; Lessner, Seth; Frishman, William H.; Panza, Julio A.; Fonarow, Gregg C.

doi:10.1016/j.amjcard.2014.04.021

Cited by 31 publications

(31 citation statements)

References 26 publications

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“…Some prior studies, however, have suggested the existence of a “smoker's paradox,” implying that the outcomes of acute myocardial infarction (MI) may be more favorable in smokers than in nonsmokers 2, 3, 4, 5, 6. More recently, smoking has also been shown to be associated with lower in‐hospital mortality in patients with acute ischemic stroke, acute heart failure, and cardiac arrest 7, 8, 9, 10…”

Section: Introductionmentioning

confidence: 99%

Smoker's Paradox in Patients With ST‐Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Gupta

Kolte

Khera

et al. 2016

JAHA

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BackgroundPrior 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 ResultsWe 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).ConclusionsIn 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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Section: Introductionmentioning

confidence: 99%

Smoker's Paradox in Patients With ST‐Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Gupta

Kolte

Khera

et al. 2016

JAHA

Self Cite

View full text Add to dashboard Cite

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“…11, 374; 2014), 1 Alexandra Roberts focuses on the large observational analysis by Gupta and colleagues on in-hospital cardiac arrest. 2 According to this analysis, smokers have higher survival rates and better neurological outcome after in-hospital cardiac arrest than nonsmokers. 2 The finding was explained by the investigators as an effect of ischaemic preconditioning, 3 whereby tobacco smoke causes regular hypoxic effects 4 leading to frequent minor ischaemia and subsequent reperfusion.…”

Section: Correspondencementioning

confidence: 99%

“…2 According to this analysis, smokers have higher survival rates and better neurological outcome after in-hospital cardiac arrest than nonsmokers. 2 The finding was explained by the investigators as an effect of ischaemic preconditioning, 3 whereby tobacco smoke causes regular hypoxic effects 4 leading to frequent minor ischaemia and subsequent reperfusion. [1][2][3]5,6 As a result, the tissue becomes preconditioned to reperfusion.…”

Section: Correspondencementioning

confidence: 99%

“…2 The finding was explained by the investigators as an effect of ischaemic preconditioning, 3 whereby tobacco smoke causes regular hypoxic effects 4 leading to frequent minor ischaemia and subsequent reperfusion. [1][2][3]5,6 As a result, the tissue becomes preconditioned to reperfusion. 2,3,6 Preconditioning mitigates the paradoxically harmful effects of reperfusion on the tissue, which occur as a result of cardiac resuscitation after major ischaemia or cardiac arrest.…”

Section: Correspondencementioning

confidence: 99%

“…[1][2][3]5,6 As a result, the tissue becomes preconditioned to reperfusion. 2,3,6 Preconditioning mitigates the paradoxically harmful effects of reperfusion on the tissue, which occur as a result of cardiac resuscitation after major ischaemia or cardiac arrest. [1][2][3]5,6 Although the phenomenon of ischaemic preconditioning is a possible explanation for the smoker's paradox, at least two alternative explanations exist.…”

Section: Correspondencementioning

confidence: 99%

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