Impact of Smoking Status on Mortality in STEMI Patients Undergoing Mechanical Reperfusion for STEMI: Insights from the ISACS–STEMI COVID-19 Registry

Abstract

The so-called “smoking paradox”, conditioning lower mortality in smokers among STEMI patients, has seldom been addressed in the settings of modern primary PCI protocols. The ISACS–STEMI COVID-19 is a large-scale retrospective multicenter registry addressing in-hospital mortality, reperfusion, and 30-day mortality among primary PCI patients in the era of the COVID-19 pandemic. Among the 16,083 STEMI patients, 6819 (42.3%) patients were active smokers, 2099 (13.1%) previous smokers, and 7165 (44.6%) non-smokers. Despite the impaired preprocedural recanalization (p < 0.001), active smokers had a significantly better postprocedural TIMI flow compared with non-smokers (p < 0.001); this was confirmed after adjustment for all baseline and procedural confounders, and the propensity score. Active smokers had a significantly lower in-hospital (p < 0.001) and 30-day (p < 0.001) mortality compared with non-smokers and previous smokers; this was confirmed after adjustment for all baseline and procedural confounders, and the propensity score. In conclusion, in our population, active smoking was significantly associated with improved epicardial recanalization and lower in-hospital and 30-day mortality compared with previous and non-smoking history.

In Hospital Outcome Among Smoker and Nonsmoker Patients Presented with ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

“…In this study, an elevated risk of heart failure and transient ischemic attack was observed in those who were exposed when compared to those who were not exposed, while mortality rate was higher among smokers compared to non-smokers. These finding were supported by De Luca G et al 12 as they observed that the active smoking was found to be significantly linked with improved epicardial recanalization and lower rates of in-hospital and 30-day mortality compared to those with a history of previous or non-smoking. In the study by Wu HP et al 13 observed that the phenomenon known as the "smoker's paradox" also applies to the long-term results of patients with stable coronary artery disease (CAD) who undergo percutaneous coronary intervention (PCI), and this can be attributed, in part, to differences in their baseline characteristics.…”

“…15 Consistently numerous previous studies conducted with thrombolysis have demonstrated that smoking is correlated with lower mortality rates in both short-and long-term follow-up periods. 12,[16][17][18] In this study, the mean body mass index in the exposed group and non-exposed group was 26.4±6. and cardiovascular disease has long been established, with smoking seems to be a significant risk factor for CAD and MI.…”