Impact of Smoking on Clinical Outcomes in Female Patients with Acute Myocardial Infarction

Abstract

Background and ObjectivesCigarette smoking has been recognized as a prominent threat to women's health. We investigated the impact of smoking on clinical outcomes in Korean female patients after acute myocardial infarction (AMI).Subjects and MethodsOut of the AMI patients who enrolled in the Korea AMI Registry, 4444 female patients were included in this study. Patients were divided into two groups-non-smoker and smoker-according to their current smoking status. We compared in-hospital mortality and major adverse cardiac events (MACE), including cardiac death, myocardial infarction, repeated percutaneous coronary intervention (PCI), or coronary artery bypass grafting during the one-year clinical follow-up period between two groups.ResultsThe non-smoker group had more hypertension (HTN) and diabetes mellitus. The levels of total cholesterol, triglyceride, and low-density lipoprotein cholesterol were higher in the non-smoker group. However, in-hospital mortality was significantly higher in the smoker group (1.0% vs. 2.4%, p=0.002), and cardiac death during the 12-month clinical follow-up was significantly more frequent in the smoker group (2.2% vs. 4.5%, p=0.003). Total MACEs during the 12 months were higher in the smoker group (4.9% vs. 6.8%, p=0.014). Smoking and HTN were independent predictors of MACE {odds ratio (OR): 1.742, 95% confidence interval (CI): 1.010-3.000, p=0.046; OR: 1.573, 95% CI: 1.003-2.466, p=0.049, respectively}.ConclusionFemale smokers with AMI showed significantly higher in-hospital mortality and MACE rates during the one-year clinical follow-up period.

Risk Scoring System for Prognosis Estimation of Multivessel Disease Among Patients with ST-Segment Elevation Myocardial Infarction

“…The data in the study were from KAMIR from November 2005 to January 2008, and the Korean Working Group on Myocardial Infarction Registry (KORMI) from February 2008 to June 2012. [12][13][14] These databases were designed to identify characteristics of Korean AMI patients, and to determine better treatment options to improve patient survival. The cohort was comprised of STEMI patients who underwent percutaneous coronary intervention (PCI) after hospital arrival.…”

The Impact of Smoking on Clinical Outcomes after Percutaneous Coronary Intervention in Women Compared to Men

“…In an investigation, smoking was characterized as the only risk factor for MACE in long-term clinical follow-up, which is in line with the findings of the present study. However, association of history of smoking with mortality was ruled out in the other study [28]. Although the prevalence of smoking has been reported to be five times higher in men compared with women [29], the risk of MI due to smoking in men is half that of women [30].…”

“…HR for female nonsmokers, male nonsmokers, and male smokers versus female smokers were (0.360, CI: 0.203-0.637), (0.562 CI: 0.337-0.937), and (0.597 CI: 0.376-0.948), respectively. [28]. Another possible explanation is that CAD is often underdiagnosed or misdiagnosed in women and hence they present at later stages with probably a more complicated condition.…”

Differential Impact of Cigarette Smoking on Prognosis in Women and Men Undergoing Percutaneous Coronary Intervention

“…According to data from the 2011 National Health Interview Survey in adults, inactivity was higher among women than men (33.2% vs 29.9%, age adjusted) and increased with age, with rates of 26.1%, 33.4%, 40%, and 52.4% among adults 18 to 44, 45 to 64, 65 to 74, and ≥75 years of age, respectively. 24 Burke et al found that smoking had distinct mechanisms of plaque instability and sudden coronary death in women, which vary by menopausal status. 25 Meanwhile, a recent review and meta-analysis about gender difference in clinical outcomes after PCI suggests that the prognosis of male patients with CAD after PCI is better than that of females.…”