Association between smoking and in-hospital mortality in patients with acute myocardial infarction: results from a prospective, multicentre, observational study in China

Song, Chenxi; Fu, Rui; Dou, Kefei; Yang, Jingang; Gao, Xiaojin; Wang, Hao; Liu, Shuai; Fan, Xiaoxue; Yang, Yuejin

doi:10.1136/bmjopen-2019-030252

Cited by 18 publications

(17 citation statements)

References 37 publications

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“… 17) 18) However, recent studies have shown that this hypothesized survival benefit in smokers with CAD no longer exists in the PCI era. 10) 11) 12) 13) 15) 27) Nevertheless, some studies have reported the “smoker's paradox.” 14) 16) These previous studies have investigated on shorter clinical outcomes compared with our results assessing 5-year clinical outcomes. 10) 11) 12) 13) Parasuraman et al 13) collected 12,656 patients with acute coronary syndrome following PCI to assess 30 day and 6 month mortality according to smoking status.…”

Section: Discussionmentioning

confidence: 95%

“… 8) 9) Previous studies have investigated the effects of smoking on clinical outcomes in patients with CAD. 10) 11) 12) 13) 14) 15) Although some studies have still reported smoker's paradox, 14) 16) numerous recent studies have shown similar or higher mortality in smokers compared to nonsmokers. 10) 11) 12) 13) 15) These discrepancies in study results are likely due to differences in study characteristics and covariate selection.…”

Section: Introductionmentioning

confidence: 99%

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Effects of Smoking on Long-Term Clinical Outcomes and Lung Cancer in Patients with Acute Myocardial Infarction

et al. 2021

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Background and Objectives Smoking is well-established as a risk factor for coronary artery disease. However, recent studies demonstrated favorable results, including reduced mortality, among smokers, which are referred to as the “smoker's paradox”. This study examined the impact of smoking on clinical outcomes in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). Methods Patients with AMI undergoing PCI between 2004 and 2014 were enrolled and classified according to smoking status. The primary endpoint was a composite of major adverse cardiovascular events (MACE) including cardiac death, myocardial infarction, stroke, and revascularization. Results Among the 10,683 patients, 4,352 (40.7%) were current smokers. Smokers were 10.7 years younger and less likely to have comorbidities such as hypertension, diabetes mellitus, chronic kidney disease, stroke, and prior PCI. Smokers had less MACE (hazard ratio [HR], 0.644; 95% confidence interval [CI], 0.594–0.698; p<0.001) and cardiac death (HR, 0.494; 95% CI, 0.443–0.551; p<0.001) compared to nonsmokers during the 5 years in an unadjusted model. However, after propensity-score matching, smokers showed higher risk of MACE (HR, 1.125; 95% CI, 1.009–1.254; p=0.034) and cardiac death (HR, 1.190; 95% CI, 1.026–1.381; p=0.022). Smoking was a strong independent predictor of lung cancer (propensity-score matched HR, 2.749; 95% CI, 1.416–5.338; p=0.003). Conclusions In contrast to the unadjusted model, smoking is associated with worse cardiovascular outcome and higher incidence of lung cancer after adjustment of various confounding factors. This result can be explained by the characteristics of smokers, which were young and had fewer comorbidities.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Effects of Smoking on Long-Term Clinical Outcomes and Lung Cancer in Patients with Acute Myocardial Infarction

et al. 2021

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“…[29] The smoker's paradox whereby smokers have an increased risk of cardiovascular diseases but have lower mortality for in-hospital HF and PTCA patients has been previously reported. [3,7] This phenomenon may mislead the public on smoking cessation and many surgeons may ignore the importance of smoking cessation counselling.…”

Section: Discussionmentioning

confidence: 99%

“…[4] Some subsequent studies also showed this so called 'smoker's paradox' phenomenon in different aspects. [3,[5][6][7] Coronary artery bypass grafting surgery (CABG) is an important method of treatment of CAD. From a surgical point of view, the impact of smoking on long-term postoperative outcomes have been reported, [2,8] while the association between smoking and in-hospital mortality in CABG patients remains controversial.…”

Section: Introductionmentioning

confidence: 99%

Association between Smoking and In-hospital mortality in Patients with Left Ventricular Dysfunction Undergoing Coronary Artery Bypass Surgery: A Propensity-matched Study

Tang

Hou

Chen

et al. 2021

Preprint

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BackgroundData on the effect of smoking on In-hospital outcome in patients with left ventricular dysfunction undergoing coronary artery bypass graft (CABG) surgery are limited. We sought to determine the influence of smoking on CABG patients with left ventricular dysfunction.MethodsA retrospective study was conducted using data from the China Heart Failure Surgery Registry database. Eligible patients with left ventricular ejection fraction less than 50% underwent isolated CABGS were included. In addition to the use of multivariate regression models, a 1 to 1 propensity scores matched analysis was performed. Our study (n=6,531) consisted of 3,635 smokers and 2896 non-smokers. Smokers were further divided into ex-smokers (n=2373) and current smokers (n=1262).ResultsThe overall in-hospital morality was 3.9%. Interestingly, current smokers have lower in-hospital mortality than non-smokers (2.3% vs 4.9%; adjusted odds ratio [OR], 0.612 [95%CI, 0.395-0.947]). No difference was detected in mortality between ex-smokers and non-smokers (3.6% vs 4.9%; adjusted OR, 0.974 [0.715-1.327]). No significant differences in other clinical end points were observed. Results of propensity-matched analyses were broadly consistent.ConclusionsIt is paradoxically that current smokers had lower in-hospital mortality than non-smokers. Future studies should be performed to further understand the biological mechanisms that may explain this ‘smoker’s paradox’ phenomenon.

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“…However, in 1973, Helmers et al reported that smokers had a lower risk of mortality than non-smokers [ 4 ]. Some subsequent studies also showed this so called ‘smoker’s paradox’ phenomenon in different aspects [ 3 , 5 – 7 ]. Coronary artery bypass grafting surgery (CABG) is an important method of treatment of CAD.…”

Section: Introductionmentioning

confidence: 94%

Association between smoking and in-hospital mortality in patients with left ventricular dysfunction undergoing coronary artery bypass surgery: a propensity-matched study

Tang

Hou

Chen

et al. 2021

BMC Cardiovasc Disord

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Background Data on the effect of smoking on In-hospital outcome in patients with left ventricular dysfunction undergoing coronary artery bypass graft (CABG) surgery are limited. We sought to determine the influence of smoking on CABG patients with left ventricular dysfunction. Methods A retrospective study was conducted using data from the China Heart Failure Surgery Registry database. Eligible patients with left ventricular ejection fraction less than 50% underwent isolated CABGS were included. In addition to the use of multivariate regression models, a 1–1 propensity scores matched analysis was performed. Our study (n = 6531) consisted of 3635 smokers and 2896 non-smokers. Smokers were further divided into ex-smokers (n = 2373) and current smokers (n = 1262). Results The overall in-hospital morality was 3.9%. Interestingly, current smokers have lower in-hospital mortality than non-smokers [2.3% vs 4.9%; adjusted odds ratio (OR) 0.612 (95% CI 0.395–0.947) ]. No difference was detected in mortality between ex-smokers and non-smokers [3.6% vs 4.9%; adjusted OR 0.974 (0.715–1.327)]. No significant differences in other clinical end points were observed. Results of propensity-matched analyses were broadly consistent. Conclusions It is paradoxically that current smokers had lower in-hospital mortality than non-smokers. Future studies should be performed to further understand the biological mechanisms that may explain this ‘smoker’s paradox’ phenomenon.

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Association between smoking and in-hospital mortality in patients with acute myocardial infarction: results from a prospective, multicentre, observational study in China

Cited by 18 publications

References 37 publications

Effects of Smoking on Long-Term Clinical Outcomes and Lung Cancer in Patients with Acute Myocardial Infarction

Effects of Smoking on Long-Term Clinical Outcomes and Lung Cancer in Patients with Acute Myocardial Infarction

Association between Smoking and In-hospital mortality in Patients with Left Ventricular Dysfunction Undergoing Coronary Artery Bypass Surgery: A Propensity-matched Study

Association between smoking and in-hospital mortality in patients with left ventricular dysfunction undergoing coronary artery bypass surgery: a propensity-matched study

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