Sakarya Tıp Dergisi (Mar 2020)
Impact of Smoking on Clinical Outcomes in ST-Elevated Myocardial Infarction Patients with Small Infarct Related Coronary Vessels
Abstract
Objective: In the literature, there is no data for the comparative efficacy of smoking status in ST-segment elevation myocardial infarction(STEMI) patients with small vessel coronary artery disease(CAD) on clinical outcomes.The aim of this study was to evaluate the in-hospital mortality and long-term outcomes of STEMI patients with small vessel coronary artery disease according to smoking status.Materials and Methods: Between January 2014 and May 2017,388 consecutive STEMI patients with small vessel CAD were included in this retrospective study.The patients were classified into two groups according to status of smoking, as smokers (n =181) and non-smokers (n =207).The primary outcome was major adverse cardiac events(MACE).The secondary end-point included in-hospital mortality.Results: During the follow-up of 24 months, MACE occurred in 25(14.1 %) patients in smokers and 12(6.3 %) patients in non-smokers(p: 0.014).The target-lesion revascularization(TLR), target-vessel revascularization(TVR) and myocardial infarction(MI) rates was found significantly higher in the smoker group as compared with the non-smoker group(p: 0.049, p: 0,012, p: 0,025, respectively).The rate of in-hospital mortality was found significantly lower in smokers (p: 0.04).In multivariate Cox analysis for 2-year MACE, after accounting for all covariables, no-smoking was associated with 58% decreased risk in the small vessel CAD population (HR: 0.42, 95% CI: 0.21-0.84).Moreover, no-smoking was associated with a decreased TLR (HR: 0.38, 95% CI: 0.14-0.99),TVR (HR:0.31, 95% CI: 0.12-0.79) and MI(HR: 0.41, 95% CI: 0.19-0.89) risk at 2-years follow up. Conclusions: In our real-world registry of patients who underwent primary percutaneous coronary intervention(PPCI),smokers had lower in-hospital mortality,but poorer outcomes during 2-year follow-up.
Keywords
