Cigarette Smoking is Paradoxically Associated With Low Mortality Risk After Acute Myocardial Infarction

Kang, Si Hyuck; Suh, Jung Won; Choi, Dong‐Ju; Chae, In Ho; Cho, Goo Yeong; Youn, Tae‐Jin; Cho, Young Seok; Yoon, Chang Hwan; Oh, Il-Young; Cho, Myeong Chan; Kim, Young Jo; Chae, Shung Chull; Kim, Joo Han; Ahn, Young Keun; Jeong, Myung Ho

doi:10.1093/ntr/nts248

Cited by 18 publications

(12 citation statements)

References 27 publications

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“…Surprisingly, both smoking and obesity were risk factors for AMI development, but were associated with decreased mortality rates after AMI. These phenomena were also observed in KAMIR [9,10,11,12]. …”

Section: Predictors Of Prognosissupporting

confidence: 61%

The scientific achievements of the decades in Korean Acute Myocardial Infarction Registry

Kim

Jeong

Lee

et al. 2014

Korean J Intern Med

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The Korea Acute Myocardial Infarction Registry (KAMIR) was the first nationwide registry data collection designed to track outcomes of patients with acute myocardial infarction (AMI). These studies reflect the current therapeutic approaches and management for AMI in Korea. The results of KAMIR could help clinicians to predict the prognosis of their patients and identify better diagnostic and treatment tools to improve the quality of care. The KAMIR score was proposed to be a predictor of the prognosis of AMI patients. Triple antiplatelet therapy, consisting of aspirin, clopidogrel and cilostazol, was effective at preventing major adverse clinical outcomes. Drug-eluting stents were effective and safe in AMI patients with no increased risk of stent thrombosis. Statin therapy was effective in Korean AMI patients, including those with very low levels of low density cholesterol. The present review summarizes the 10-year scientific achievements of KAMIR from admission to outpatient care during long-term clinical follow-up.

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Section: Predictors Of Prognosissupporting

confidence: 61%

The scientific achievements of the decades in Korean Acute Myocardial Infarction Registry

Kim

Jeong

Lee

et al. 2014

Korean J Intern Med

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“…Nearly all studies have reported lower 30-day and 1-year unadjusted mortality for smokers but lower,[6, 7, 10, 11] comparable,[4, 5, 8, 9, 13] or even higher[12] risk of mortality after adjustment. Inconsistencies between studies are likely due to differences in study samples, length of follow-up, covariate adjustment, and the categorization of smokers.…”

Section: Discussionmentioning

confidence: 99%

Smoking status and life expectancy after acute myocardial infarction in the elderly

Bucholz

Beckman

Kiefe

et al. 2015

Heart

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Objective Smokers have lower short-term mortality after acute myocardial infarction than non-smokers; however, little is known about the long-term effects of smoking on life expectancy after AMI. The study aimed to quantify the burden of smoking after AMI using life expectancy and years of life lost. Methods We analyzed data from the Cooperative Cardiovascular Project, a medical record study of 158,349 elderly Medicare patients with AMI and over 17 years of follow-up, to evaluate the age-specific association of smoking with life expectancy and years of life lost after AMI. Results Our sample included 23,447 (14.8%) current smokers. Current smokers had lower crude mortality up to 5 years, which was largely explained by their younger age at AMI. After adjustment other patient characteristics, smoking was associated with lower 30-day (HR 0.91, 95% confidence interval (CI) 0.87–0.94) but higher long-term mortality (17-year HR 1.19, 95% CI 1.17–1.20) after AMI. Overall, crude life expectancy estimates were lower for current smokers than non-smokers at all ages, which translated into sizeable numbers of life-years lost attributable to smoking. As age at AMI increased, the magnitude of life-years lost due to smoking decreased. After full risk adjustment, the differences in life expectancy between current smokers and non-smokers persisted at all ages. Conclusions Current smoking is associated with lower life expectancy and large numbers of life-years lost after AMI. Our findings lend additional support to smoking cessation efforts after AMI.

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“…While the smoker's paradox in cardiovascular disease patients has been partly explained by younger age of onset and fewer coexisting high-risk features in patients with AMI who are current smokers, a small number of studies have shown that the residual lower mortality risk persists despite comprehensive covariate adjustment. 2,[10][11][12][13] Aune et al 14 published a systematic review in 2011 reporting that the paradox was observed in some studies of AMI patients in the prethrombolytic and thrombolytic era, whereas no studies of a contemporary population with acute coronary syndrome have found evidence for such a paradox. Furthermore, some angiographic studies have demonstrated that coronary artery occlusion in smokers is predominantly caused by thrombosis and thus may have a better response to spontaneous or therapeutic thrombolysis.…”

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confidence: 99%

Paradoxical Association of Smoking With In‐Hospital Mortality Among Patients Admitted With Acute Ischemic Stroke

Ali

Smith

Bhatt

et al. 2013

JAHA

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BackgroundCompared to those who never smoked, a paradoxical effect of smoking on reducing mortality in patients admitted with myocardial ischemia has been reported. We sought to determine if this effect was present in patients hospitalized with ischemic stroke.Methods and ResultsUsing the local Get with the Guidelines‐Stroke registry, we analyzed 4305 consecutively admitted ischemic stroke patients (March 2002–December 2011). The sample was divided into smokers versus nonsmokers. The main outcome of interest was the overall inpatient mortality. Compared to nonsmokers, tobacco smokers were younger, more frequently male and presented with fewer stroke risk factors such as hypertension, hyperlipidemia, diabetes, coronary artery disease, and atrial fibrillation. Smokers also had a lower average NIH Stroke Scale (NIHSS) and fewer received tissue plasminogen activator (tPA). Patients in both groups had similar adherence to early antithrombotics, dysphagia screening prior to oral intake, and deep vein thrombosis (DVT) prophylaxis. Smoking was associated with lower all‐cause in‐hospital mortality (6.6% versus 12.4%; unadjusted OR 0.46; CI [0.34 to 0.63]; P<0.001). In multivariable analysis, adjusted for age, gender, ethnicity, hypertension, diabetes mellitus, hyperlipidemia, CAD, atrial fibrillation, NIHSS, and tPA, smoking remained independently associated with lower mortality (adjusted OR 0.64; CI [0.42 to 0.96]; P=0.03).ConclusionsSimilar to myocardial ischemia, smoking was independently associated with lower inpatient mortality in acute ischemic stroke. This effect may be due to tobacco‐induced changes in cerebrovascular vasoreactivity, or may be due in part to residual confounding. Larger, multicenter studies are needed to confirm the finding and the effect on 30‐day and 1‐year mortality.

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Cigarette Smoking is Paradoxically Associated With Low Mortality Risk After Acute Myocardial Infarction

Abstract: In this study, in which the patients received up-to-date treatment options, smoking was associated with a 48% decrease in the risk of all-cause mortality at 1 year after AMI.

Cited by 18 publications

References 27 publications

The scientific achievements of the decades in Korean Acute Myocardial Infarction Registry

The scientific achievements of the decades in Korean Acute Myocardial Infarction Registry

Smoking status and life expectancy after acute myocardial infarction in the elderly

Paradoxical Association of Smoking With In‐Hospital Mortality Among Patients Admitted With Acute Ischemic Stroke

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