Korean Circ J.  2015 Jan;45(1):22-27. 10.4070/kcj.2015.45.1.22.

Impact of Smoking on Clinical Outcomes in Female Patients with Acute Myocardial Infarction

• Jeong YA
• Jeong MH
• Jeong HC
• Ahn Y
• Kim YJ
• Kim CJ
• Cho MC
• Korea Acute Myocardial Infarction Registry (KAMIR) Investigators

• KMID: 2223842
• DOI: http://doi.org/10.4070/kcj.2015.45.1.22

Abstract

BACKGROUND AND OBJECTIVES
Cigarette smoking has been recognized as a prominent threat to women's health. We investigated the impact of smoking on clinical outcomes in Korean female patients after acute myocardial infarction (AMI).
SUBJECTS AND METHODS
Out of the AMI patients who enrolled in the Korea AMI Registry, 4444 female patients were included in this study. Patients were divided into two groups-non-smoker and smoker-according to their current smoking status. We compared in-hospital mortality and major adverse cardiac events (MACE), including cardiac death, myocardial infarction, repeated percutaneous coronary intervention (PCI), or coronary artery bypass grafting during the one-year clinical follow-up period between two groups.
RESULTS
The non-smoker group had more hypertension (HTN) and diabetes mellitus. The levels of total cholesterol, triglyceride, and low-density lipoprotein cholesterol were higher in the non-smoker group. However, in-hospital mortality was significantly higher in the smoker group (1.0% vs. 2.4%, p=0.002), and cardiac death during the 12-month clinical follow-up was significantly more frequent in the smoker group (2.2% vs. 4.5%, p=0.003). Total MACEs during the 12 months were higher in the smoker group (4.9% vs. 6.8%, p=0.014). Smoking and HTN were independent predictors of MACE {odds ratio (OR): 1.742, 95% confidence interval (CI): 1.010-3.000, p=0.046; OR: 1.573, 95% CI: 1.003-2.466, p=0.049, respectively}.
CONCLUSION
Female smokers with AMI showed significantly higher in-hospital mortality and MACE rates during the one-year clinical follow-up period.

Keyword

Hospital mortality; Myocardial infarction; Female; Smoking

MeSH Terms

Cholesterol
Coronary Artery Bypass
Death
Diabetes Mellitus
Female
Follow-Up Studies
Hospital Mortality
Humans
Hypertension
Korea
Lipoproteins
Myocardial Infarction*
Percutaneous Coronary Intervention
Smoke*
Smoking*
Triglycerides
Women's Health
Cholesterol
Lipoproteins
Smoke

Reference

1. Statistics Korea. 2012 Death Statistics. Daejeon: Statistics Korea;2012.

2. Jang SY, Ju EY, Cho SI, Lee SW, Kim DK. Comparison of cardiovascular risk factors for peripheral artery disease and coronary artery disease in the Korean population. Korean Circ J. 2013; 43:316–328.

3. Prescott E, Osler M, Andersen PK, et al. Mortality in women and men in relation to smoking. Int J Epidemiol. 1998; 27:27–32.

4. Lee JH, Lee H, Bae MH, et al. Gender differences among Korean patients with coronary spasm. Korean Circ J. 2009; 39:423–427.

5. Njølstad I, Arnesen E, Lund-Larsen PG. Smoking, serum lipids, blood pressure, and sex differences in myocardial infarction. A 12-year follow-up of the Finnmark Study. Circulation. 1996; 93:450–456.

6. Nauta ST, Deckers JW, van Domburg RT, Akkerhuis KM. Sex-related trends in mortality in hospitalized men and women after myocardial infarction between 1985 and 2008: equal benefit for women and men. Circulation. 2012; 126:2184–2189.

7. Shiraki T, Saito D. Sex difference of in-hospital mortality in patients with acute myocardial infarction. Acta Med Okayama. 2011; 65:307–314.

8. Sim DS, Jeong MH, Cho KH, et al. Effect of early statin treatment in patients with cardiogenic shock complicating acute myocardial infarction. Korean Circ J. 2013; 43:100–109.

9. Ellis SG, Vandormael MG, Cowley MJ, et al. Coronary morphologic and clinical determinants of procedural outcome with angioplasty for multivessel coronary disease. Implications for patient selection. Multivessel Angioplasty Prognosis Study Group. Circulation. 1990; 82:1193–1202.

10. TIMI Study Group. The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. N Engl J Med. 1985; 312:932–936.

11. Park JS, Lee HJ, Kim YJ, et al. The epidemiological and clinical characteristics of patients admitted for coronary angiography to evaluate ischemic heart disease. Korean J Intern Med. 2007; 22:87–92.

12. Grundtvig M, Hagen TP, Amrud ES, Reikvam A. Reduced life expectancy after an incident hospital diagnosis of acute myocardial infarction-effects of smoking in women and men. Int J Cardiol. 2013; 167:2792–2797.

13. Wijnbergen I, Tijssen J, van't Veer M, Michels R, Pijls NH. Gender differences in long-term outcome after primary percutaneous intervention for ST-segment elevation myocardial infarction. Catheter Cardiovasc Interv. 2013; 82:379–384.

14. Nyboe J, Jensen G, Appleyard M, Schnohr P. Smoking and the risk of first acute myocardial infarction. Am Heart J. 1991; 122:438–447.

15. Tverdal A, Thelle D, Stensvold I, Leren P, Bjartveit K. Mortality in relation to smoking history: 13 years' follow-up of 68,000 Norwegian men and women 35-49 years. J Clin Epidemiol. 1993; 46:475–487.

16. Seol SY, Lee SJ, Jeong MH, et al. Clinical outcomes of persistent smoking in patients with acute myocardial infarction who underwent percutaneous coronary intervention. Korean J Med. 2011; 80:562–570.

17. Choi YJ, Park JS, Kim U, et al. Changes in smoking behavior and adherence to preventive guidelines among smokers after a heart attack. J Geriatr Cardiol. 2013; 10:146–150.

18. Kim MS, Jeong MH, Hwang SH, et al. Clinical pattern changes in elderly patients who underwent percutaneous coronary intervention in the last ten years. Korean J Med. 2010; 79:661–672.

19. Choi MJ, Jeong MH, Hwang SY. Restenosis and compliance with self-care among acute coronary syndrome patients undergoing follow-up angiograms. Korean J Health Promot. 2011; 11:34–41.

20. Choi MJ, Jeong MH, Cho JY, et al. Predictive factors for long-term clinical outcomes in patients with variant angina. Korean J Med. 2013; 84:522–530.

21. Rosenberg L, Hennekens CH, Rosner B, Belanger C, Rothman KJ, Speizer FE. Early menopause and the risk of myocardial infarction. Am J Obstet Gynecol. 1981; 139:47–51.