EClinicalMedicine (Jan 2024)

Carbon monoxide and prognosis in smokers hospitalised with acute cardiac events: a multicentre, prospective cohort studyResearch in context

  • Jean-Guillaume Dillinger,
  • Théo Pezel,
  • Clément Delmas,
  • Guillaume Schurtz,
  • Antonin Trimaille,
  • Nicolas Piliero,
  • Claire Bouleti,
  • Benoit Lattuca,
  • Stéphane Andrieu,
  • Julien Fabre,
  • Reza Rossanaly Vasram,
  • Jean-Claude Dib,
  • Victor Aboyans,
  • Charles Fauvel,
  • Francois Roubille,
  • Edouard Gerbaud,
  • Albert Boccara,
  • Etienne Puymirat,
  • Solenn Toupin,
  • Eric Vicaut,
  • Patrick Henry,
  • Victor Aboyans,
  • Emeric Albert,
  • Franck Albert,
  • Sean Alvain,
  • Nabil Amri,
  • Stéphane Andrieu,
  • Sabir Attou,
  • Simon Auvray,
  • Sonia Azzakani,
  • Ruben Azencot,
  • Marc Bedossa,
  • Franck Boccara,
  • Albert Boccara,
  • Thomas Bochaton,
  • Eric Bonnefoy-Cudraz,
  • Guillaume Bonnet,
  • Guillaume Bonnet,
  • Nabil Bouali,
  • Océane Bouchot,
  • Claire Bouleti,
  • Tanissia Boukertouta,
  • Jean-Baptiste Brette,
  • Marjorie Canu,
  • Aures Chaib,
  • Clement Charbonnel,
  • Anne-Solene Chaussade,
  • Alexandre Coppens,
  • Yves Cottin,
  • Arthur Darmon,
  • Elena de Angelis,
  • Clément Delmas,
  • Laura Delsarte,
  • Antoine Deney,
  • Jean-Claude Dib,
  • Jean-Guillaume Dillinger,
  • Clemence Docq,
  • Valentin Dupasquier,
  • Meyer Elbaz,
  • Antony El Hadad,
  • Amine El Ouahidi,
  • Nacim Ezzouhairi,
  • Julien Fabre,
  • Damien Fard,
  • Charles Fauvel,
  • Édouard Gerbaud,
  • Martine Gilard,
  • Marc Goralski,
  • Nissim Grinberg,
  • Alain Grentzinger,
  • Marie Hauguel-Moreau,
  • Patrick Henry,
  • Fabien Huet,
  • Thomas Landemaine,
  • Benoit Lattuca,
  • Léo Lemarchand,
  • Thomas Levasseur,
  • Pascal Lim,
  • Laura Maitre Ballesteros,
  • Nicolas Mansencal,
  • Benjamin Marie,
  • David Martinez,
  • Benoit Merat,
  • Christophe Meune,
  • Damien Millischer,
  • Thomas Moine,
  • Pascal Nhan,
  • Nathalie Noirclerc,
  • Patrick Ohlmann,
  • Théo Pezel,
  • Fabien Picard,
  • Nicolas Piliero,
  • Thibaut Pommier,
  • Etienne Puymirat,
  • Arthur Ramonatxo,
  • Reza Rossanaly Vasram,
  • François Roubille,
  • Vincent Roule,
  • Guillaume Schurtz,
  • Mathilde Stevenard,
  • David Sulman,
  • Fédérico Swedsky,
  • Victoria Tea,
  • Eugénie Thevenet,
  • Christophe Thuaire,
  • Antonin Trimaille,
  • Christophe Tron,
  • Guillaume Viboud,
  • Dominique Yomi,
  • Cyril Zakine

Journal volume & issue
Vol. 67
p. 102401

Abstract

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Summary: Background: Smoking cigarettes produces carbon monoxide (CO), which can reduce the oxygen-carrying capacity of the blood. We aimed to determine whether elevated expiratory CO levels would be associated with a worse prognosis in smokers presenting with acute cardiac events. Methods: From 7 to 22 April 2021, expiratory CO levels were measured in a prospective registry including all consecutive patients admitted for acute cardiac event in 39 centres throughout France. The primary outcome was 1-year all-cause death. Initial in-hospital major adverse cardiac events (MAE; death, resuscitated cardiac arrest and cardiogenic shock) were also analysed. The study was registered at ClinicalTrials.gov (NCT05063097). Findings: Among 1379 patients (63 ± 15 years, 70% men), 368 (27%) were active smokers. Expiratory CO levels were significantly raised in active smokers compared to non-smokers. A CO level >11 parts per million (ppm) found in 94 (25.5%) smokers was associated with a significant increase in death (14.9% for CO > 11 ppm vs. 2.9% for CO ≤ 11 ppm; p 11 ppm was associated with a significant increase in MAE in smokers during initial hospitalisation after adjustment for comorbidities (odds ratio [OR] 15.75, 95% CI [5.56–44.60]) or parameters of in-hospital severity (OR 10.67, 95% CI [4.06–28.04]). In the overall population, CO > 11 ppm but not smoking was associated with an increased rate of all-cause death (HR 4.03, 95% CI [2.33–6.98] and 1.66 [0.96–2.85] respectively). Interpretation: Elevated CO level is independently associated with a 6-fold increase in 1-year death and 10-fold in-hospital MAE in smokers hospitalized for acute cardiac events. Funding: Grant from Fondation Coeur & Recherche.

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