The bizzare phenomenon of smokers’ paradox in the immediate outcome post acute myocardial infarction: an insight into the Malaysian National Cardiovascular Database-Acute Coronary Syndrome (NCVD-ACS) registry year 2006–2013

Venkatason, Padmaa; Salleh, Norsabihin Mohd; Zubairi, Yong Zulina; Hafidz, Imran; Ahmad, Wan Azman Wan; Han, Sim Kui; Zuhdi, Ahmad Syadi Mahmood

doi:10.1186/s40064-016-2188-3

Cited by 35 publications

(36 citation statements)

References 23 publications

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“…This is supported by the National Health and Morbidity Survey Malaysia which stated that the Malaysian population has a higher prevalence of smoking with the prevalence of adult male smokers being 46.5%. 25 , 26 This is consistent with the NCVD database registry annual reports. 12 Moreover, a high prevalence of smoking (48.7%) and hypertension (31.7%) among male residents in rural Selangor, Malaysia were found in another study.…”

Section: Discussionsupporting

confidence: 88%

Gender differences in mortality among ST elevation myocardial infarction patients in Malaysia from 2006 to 2013

Juhan

Zubairi

Zuhdi

et al. 2018

Annals of Saudi Medicine

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BACKGROUNDCoronary artery disease (CAD) is one of the leading causes of death in Malaysia. However, the prevalence of CAD in males is higher than in females and mortality rates are also different between the two genders. This suggest that risk factors associated with mortality between males and females are different, so we compared the clinical characteristics and outcome between male and female STEMI patients.OBJECTIVESTo identify the risk factors associated with mortality for each gender and compare differences, if any, among ST-elevation myocardial infarction (STEMI) patients.DESIGNRetrospective analysis.SETTINGSHospitals across Malaysia.PATIENTS AND METHODSWe analyzed data on all STEMI patients in the National Cardiovascular Database-Acute coronary syndrome (NCVD-ACS) registry for the years 2006 to 2013 (8 years). We collected demographic and risk factor data (diabetes mellitus, hypertension, smoking status, dyslipidaemia and family history of CAD). Significant variables from the univariate analysis were further analysed by a multivariate logistic analysis to identify risk factors and compare by gender.MAIN OUTCOME MEASURESDifferential risk factors for each gender.RESULTSFor the 19 484 patients included in the analysis, the mortality rate over the 8 years was significantly higher in females (15.4%) than males (7.5%) (P<.001). The univariate analysis showed that the majority of male patients <65 years while females were ≥65 years. The most prevalent risk factors for male patients were smoking (79.3%), followed by hypertension (54.9%) and diabetes mellitus (40.4%), while the most prevalent risk factors for female patients were hypertension (76.8%), followed by diabetes mellitus (60%) and dyslipidaemia (38.1%). The final model for male STEMI patients had seven significant variables: Killip class, age group, hypertension, renal disease, percutaneous coronary intervention and family history of CVD. For female STEMI patients, the significant variables were renal disease, smoking status, Killip class and age group.CONCLUSIONGender differences existed in the baseline characteristics, associated risk factors, clinical presentation and outcomes among STEMI patients. For STEMI females, the rate of mortality was twice that of males. Once they reach menopausal age, when there is less protection from the estrogen hormone and there are other risk factors, menopausal females are at increased risk for STEMI.LIMITATIONRetrospective registry data with inter-hospital variation.

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Section: Discussionsupporting

confidence: 88%

Gender differences in mortality among ST elevation myocardial infarction patients in Malaysia from 2006 to 2013

Juhan

Zubairi

Zuhdi

et al. 2018

Annals of Saudi Medicine

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“…The other interesting nding of the present study was former smoker closely linked to good responder of stem cell therapy in the EnD-CAD patients. This association was compatible with the previous misleading phenomenon of "smoker's paradox" [33,34], indicating better clinical outcomes were observed among the smokers suffering from acute myocardial infarction. Recent clinical researches [35,36] have debunked that bizarre "smoker's paradox" was mainly affected by age factor because the majority of smokers presenting to hospital were ten years younger than nonsmokers.…”

Section: Discussionsupporting

confidence: 87%

Baseline factors identified for prediction of good responders in patients with end-stage diffuse coronary artery disease undergoing intracoronary CD34+ cell therapy

Sung

Chiang

et al. 2020

Preprint

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Abstract Background: Treating patients with end-stage diffuse coronary artery disease (EnD-CAD) unsuitable for coronary intervention remains a clinical challenge. They usually express refractory angina and have high risk for mortality. Although growing data have indicated cell therapy is an alternative solution to medical or invasive therapy, there are still lacking useful markers to predict whether heart function will improve in the EnD-CAD patients who underwent circulatory-derived CD34+ cell therapy. By utilizing the baseline variables and results from our previous phase I/II clinical trials, the aim of this study tried to elucidate the variables predictive of the “good response” to CD34+ cell therapy.Methods: This retrospective study included 38 patients in the phase I clinical trial (2011-2014), and 30 patients in the phase II clinical trial (2013-2017). These patients were categorized into “good responders” and “non-responders” according to their 1-year improvement of LVEF ≥7.0% or <7.0% after intracoronary CD34+ cell therapy. Univariate and multivariate logistic regression models were performed to identify potential independent predictors of good responder to cell therapy, followed by Hosmer–Lemeshow (H-L) test for goodness of fit and prediction power.Results: Among baseline data, multivariate analysis demonstrated that history of former smoker was independently predictive of good responders (p=0.006). On the other hand, male gender, the baseline Canadian Cardiovascular Society angina score ≥3 and grades of LV diastolic dysfunction ≥2 were significantly negative predictors of good responders (all p<0.01). After administration of subcutaneous granulocyte-colony stimulating factor (G-CSF), a higher post-G-CSF neutrophil count in addition to the above four baseline variables also played crucial roles in early prediction of good response to CD34+ cell therapy for EnD-CAD (all p<0.03). The H-L test displayed a good prediction power with sensitivity 83.3%, specificity 85.3% and accuracy 84.4%. Conclusions: Using the results of our phase I/II clinical trials, previous smoking habit, female sex, lower grades of angina score and diastolic dysfunction were identified to be independently predictive of “good response” to CD34+ cell therapy in the patients with EnD-CAD.Trial registration: This is a retrospective analysis based on the phase I (ISRCTN72853206) and II (ISRCTN26002902) clinical trials

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“…In our study, this can be attributed to the low atherosclerotic risk profile of the smoker group with relatively younger age, lesser prevalence of diabetes and hypertension, and less severe coronary anatomy (MVD). It has been reported that with an appropriate adjustment of these confounding factors, the dubious benefit of smoking diminishes [12], and studies have reported poor postecoronary revascularization follow-up in smokers [12,18,25,28,30].…”

Section: Multivessel Diseasementioning

confidence: 99%

Clinical, Angiographic Characteristics and In-Hospital Outcomes of Smoker and Nonsmoker Patients After Primary Percutaneous Coronary Intervention

Ashraf

Afaque

Aziz

et al. 2019

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Background: Smoking is a well-established cardiac risk factor there is dearth of Local data regarding clinical and angiographic characteristics of smoker patients. Objectives: This study was planned to assess the differences in the clinical characteristics, angiographic characteristics, and in-hospital outcomes of smokers and nonsmokers after primary percutaneous coronary intervention at a tertiary care hospital in Karachi, Pakistan. Methods: We included patients between 40 and 80 years of age diagnosed with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention from July 1, 2017, to March 31, 2018. Clinical and angiographic characteristics and in-hospital outcomes were obtained from the cases submitted to the National Cardiovascular Data Registry's CathPCI (CatheterizationePercutaneous Coronary Intervention) Registry from our site. Results: A total of 3,255 patients were included in this study. Smokers consist of 25.1% (817) of the total sample. A high majority of smokers were male, 98.8% (807), and smokers were relatively younger as compared to nonsmokers with a mean age of 52.89 AE 10.59 versus 55.98 AE 11.24 years; p < 0.001. Smokers had higher post-procedure TIMI (Thrombolysis In Myocardial Infarction) flow grade III: 97.8% (794) versus 95.53% (2,329); p ¼ 0.037, and they had a relatively low mortality rate: 2.69% (22) versus 3.16% (77); p ¼ 0.502. Conclusions: Smokers were predominantly male and around 3 years younger than nonsmokers. Diabetes mellitus and hypertension were less common among smokers and single-vessel disease was the more common angiographic finding for smokers as compared to 3-vessel disease for nonsmokers. No statistically significant differences in in-hospital outcomes were observed. ST-segment elevation myocardial infarction in smokers despite younger age and the low atherosclerotic risk profile, in our region, emphasize the need for nicotine addiction management and smoking cessation campaigns at large and for pre-discharge counseling.

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The bizzare phenomenon of smokers’ paradox in the immediate outcome post acute myocardial infarction: an insight into the Malaysian National Cardiovascular Database-Acute Coronary Syndrome (NCVD-ACS) registry year 2006–2013

Cited by 35 publications

References 23 publications

Gender differences in mortality among ST elevation myocardial infarction patients in Malaysia from 2006 to 2013

Gender differences in mortality among ST elevation myocardial infarction patients in Malaysia from 2006 to 2013

Baseline factors identified for prediction of good responders in patients with end-stage diffuse coronary artery disease undergoing intracoronary CD34+ cell therapy

Clinical, Angiographic Characteristics and In-Hospital Outcomes of Smoker and Nonsmoker Patients After Primary Percutaneous Coronary Intervention

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