Effect of Smoking on Infarct Size and Major Adverse Cardiac Events in Patients With Large Anterior ST-Elevation Myocardial Infarction (from the INFUSE-AMI Trial)

Giustino Gennaro, Sorin J. Brener, Björn Redfors, Ajay J. Kirtane, Philippe Genereux, Akiko Maehara, Thomas Neunteufl, D. Christopher Metzger, Roxana Mehran, C. Michael Gibson, Gregg W. Stone

Research output: Contribution to journalArticle

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Abstract

We sought to investigate the effect of smoking on infarct size (IS) and major adverse cardiac events (MACE) in patients with large anterior ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Participants from the Intracoronary Abciximab and Aspiration Thrombectomy in Patients with Large Anterior Myocardial Infarction study were categorized according to smoking status (current or previous smoking vs no history of smoking). The primary imaging outcome was cardiac magnetic resonance imaging–assessed IS of left ventricular mass (%) at 30 days. The primary clinical outcome was the rate of MACE at 30 days and 1 year, defined as the composite of death, reinfarction, new-onset heart failure, or rehospitalization. Of 447 patients enrolled in Intracoronary Abciximab and Aspiration Thrombectomy in Patients with Large Anterior Myocardial Infarction, 271 (60.6%) were current or past smokers. Compared with nonsmokers, smokers were almost 10 years younger and had a lower prevalence of clinical co-morbidities. Smokers had better procedural success and angiographic reperfusion compared with nonsmokers. At 30 days, there were no differences between smokers and nonsmokers in median IS (16.8% vs 17.4%, p = 0.67) or metrics of left ventricular function. By multivariable linear regression analysis, smoking was not significantly associated with IS at 30 days (beta coefficient: 0.83, p = 0.42). At 1 year, smokers had lower crude rates of MACE (7.6% vs 15%, p = 0.01). After multivariable adjustment, there were no significant differences in 1-year MACE between smokers and nonsmokers (adjusted hazard ratio 0.73, 95% CI 0.40 to 1.33, p = 0.30). In conclusion, smoking history had no significant effect on IS at 30 days. Although current or previous smokers had lower rates of 1-year MACE than those with no history of smoking, adjustment for baseline characteristics rendered this association nonsignificant. These findings support the hypothesis that the smoker's paradox is largely attributable to differences in demographic and clinical baseline risk, rather than differences in IS after primary percutaneous coronary intervention.

Original languageEnglish (US)
Pages (from-to)1097-1104
Number of pages8
JournalAmerican Journal of Cardiology
Volume118
Issue number8
DOIs
StatePublished - Oct 15 2016
Externally publishedYes

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Smoking
Thrombectomy
Percutaneous Coronary Intervention
Myocardial Infarction
Social Adjustment
ST Elevation Myocardial Infarction
Left Ventricular Function
Reperfusion
Linear Models
Magnetic Resonance Spectroscopy
Heart Failure
History
Regression Analysis
Demography
Morbidity
abciximab

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Gennaro, Giustino ; Brener, Sorin J. ; Redfors, Björn ; Kirtane, Ajay J. ; Genereux, Philippe ; Maehara, Akiko ; Neunteufl, Thomas ; Metzger, D. Christopher ; Mehran, Roxana ; Gibson, C. Michael ; Stone, Gregg W. / Effect of Smoking on Infarct Size and Major Adverse Cardiac Events in Patients With Large Anterior ST-Elevation Myocardial Infarction (from the INFUSE-AMI Trial). In: American Journal of Cardiology. 2016 ; Vol. 118, No. 8. pp. 1097-1104.
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title = "Effect of Smoking on Infarct Size and Major Adverse Cardiac Events in Patients With Large Anterior ST-Elevation Myocardial Infarction (from the INFUSE-AMI Trial)",
abstract = "We sought to investigate the effect of smoking on infarct size (IS) and major adverse cardiac events (MACE) in patients with large anterior ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Participants from the Intracoronary Abciximab and Aspiration Thrombectomy in Patients with Large Anterior Myocardial Infarction study were categorized according to smoking status (current or previous smoking vs no history of smoking). The primary imaging outcome was cardiac magnetic resonance imaging–assessed IS of left ventricular mass ({\%}) at 30 days. The primary clinical outcome was the rate of MACE at 30 days and 1 year, defined as the composite of death, reinfarction, new-onset heart failure, or rehospitalization. Of 447 patients enrolled in Intracoronary Abciximab and Aspiration Thrombectomy in Patients with Large Anterior Myocardial Infarction, 271 (60.6{\%}) were current or past smokers. Compared with nonsmokers, smokers were almost 10 years younger and had a lower prevalence of clinical co-morbidities. Smokers had better procedural success and angiographic reperfusion compared with nonsmokers. At 30 days, there were no differences between smokers and nonsmokers in median IS (16.8{\%} vs 17.4{\%}, p = 0.67) or metrics of left ventricular function. By multivariable linear regression analysis, smoking was not significantly associated with IS at 30 days (beta coefficient: 0.83, p = 0.42). At 1 year, smokers had lower crude rates of MACE (7.6{\%} vs 15{\%}, p = 0.01). After multivariable adjustment, there were no significant differences in 1-year MACE between smokers and nonsmokers (adjusted hazard ratio 0.73, 95{\%} CI 0.40 to 1.33, p = 0.30). In conclusion, smoking history had no significant effect on IS at 30 days. Although current or previous smokers had lower rates of 1-year MACE than those with no history of smoking, adjustment for baseline characteristics rendered this association nonsignificant. These findings support the hypothesis that the smoker's paradox is largely attributable to differences in demographic and clinical baseline risk, rather than differences in IS after primary percutaneous coronary intervention.",
author = "Giustino Gennaro and Brener, {Sorin J.} and Bj{\"o}rn Redfors and Kirtane, {Ajay J.} and Philippe Genereux and Akiko Maehara and Thomas Neunteufl and Metzger, {D. Christopher} and Roxana Mehran and Gibson, {C. Michael} and Stone, {Gregg W.}",
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Gennaro, G, Brener, SJ, Redfors, B, Kirtane, AJ, Genereux, P, Maehara, A, Neunteufl, T, Metzger, DC, Mehran, R, Gibson, CM & Stone, GW 2016, 'Effect of Smoking on Infarct Size and Major Adverse Cardiac Events in Patients With Large Anterior ST-Elevation Myocardial Infarction (from the INFUSE-AMI Trial)', American Journal of Cardiology, vol. 118, no. 8, pp. 1097-1104. https://doi.org/10.1016/j.amjcard.2016.07.019

Effect of Smoking on Infarct Size and Major Adverse Cardiac Events in Patients With Large Anterior ST-Elevation Myocardial Infarction (from the INFUSE-AMI Trial). / Gennaro, Giustino; Brener, Sorin J.; Redfors, Björn; Kirtane, Ajay J.; Genereux, Philippe; Maehara, Akiko; Neunteufl, Thomas; Metzger, D. Christopher; Mehran, Roxana; Gibson, C. Michael; Stone, Gregg W.

In: American Journal of Cardiology, Vol. 118, No. 8, 15.10.2016, p. 1097-1104.

Research output: Contribution to journalArticle

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AU - Brener, Sorin J.

AU - Redfors, Björn

AU - Kirtane, Ajay J.

AU - Genereux, Philippe

AU - Maehara, Akiko

AU - Neunteufl, Thomas

AU - Metzger, D. Christopher

AU - Mehran, Roxana

AU - Gibson, C. Michael

AU - Stone, Gregg W.

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N2 - We sought to investigate the effect of smoking on infarct size (IS) and major adverse cardiac events (MACE) in patients with large anterior ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Participants from the Intracoronary Abciximab and Aspiration Thrombectomy in Patients with Large Anterior Myocardial Infarction study were categorized according to smoking status (current or previous smoking vs no history of smoking). The primary imaging outcome was cardiac magnetic resonance imaging–assessed IS of left ventricular mass (%) at 30 days. The primary clinical outcome was the rate of MACE at 30 days and 1 year, defined as the composite of death, reinfarction, new-onset heart failure, or rehospitalization. Of 447 patients enrolled in Intracoronary Abciximab and Aspiration Thrombectomy in Patients with Large Anterior Myocardial Infarction, 271 (60.6%) were current or past smokers. Compared with nonsmokers, smokers were almost 10 years younger and had a lower prevalence of clinical co-morbidities. Smokers had better procedural success and angiographic reperfusion compared with nonsmokers. At 30 days, there were no differences between smokers and nonsmokers in median IS (16.8% vs 17.4%, p = 0.67) or metrics of left ventricular function. By multivariable linear regression analysis, smoking was not significantly associated with IS at 30 days (beta coefficient: 0.83, p = 0.42). At 1 year, smokers had lower crude rates of MACE (7.6% vs 15%, p = 0.01). After multivariable adjustment, there were no significant differences in 1-year MACE between smokers and nonsmokers (adjusted hazard ratio 0.73, 95% CI 0.40 to 1.33, p = 0.30). In conclusion, smoking history had no significant effect on IS at 30 days. Although current or previous smokers had lower rates of 1-year MACE than those with no history of smoking, adjustment for baseline characteristics rendered this association nonsignificant. These findings support the hypothesis that the smoker's paradox is largely attributable to differences in demographic and clinical baseline risk, rather than differences in IS after primary percutaneous coronary intervention.

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