Korean Circ J.  2021 Apr;51(4):336-348. 10.4070/kcj.2020.0430.

Effects of Smoking on Long-Term Clinical Outcomes and Lung Cancer in Patients with Acute Myocardial Infarction

• Lee SN
• Choi IJ
• Lim S
• Choo EH
• Hwang BH
• Kim CJ
• Park MW
• Lee JM
• Park CS
• Kim HY
• Yoo KD
• Jeon DS
• Youn HJ
• Chung WS
• Kim MC
• Jeong MH
• Ahn Y
• Chang K

• KMID: 2514637
• DOI: http://doi.org/10.4070/kcj.2020.0430

Abstract

Background and Objectives
Smoking is well-established as a risk factor for coronary artery disease. However, recent studies demonstrated favorable results, including reduced mortality, among smokers, which are referred to as the “smoker's paradox”. This study examined the impact of smoking on clinical outcomes in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI).
Methods
Patients with AMI undergoing PCI between 2004 and 2014 were enrolled and classified according to smoking status. The primary endpoint was a composite of major adverse cardiovascular events (MACE) including cardiac death, myocardial infarction, stroke, and revascularization.
Results
Among the 10,683 patients, 4,352 (40.7%) were current smokers. Smokers were 10.7 years younger and less likely to have comorbidities such as hypertension, diabetes mellitus, chronic kidney disease, stroke, and prior PCI. Smokers had less MACE (hazard ratio [HR], 0.644; 95% confidence interval [CI], 0.594–0.698; p<0.001) and cardiac death (HR, 0.494; 95% CI, 0.443–0.551; p<0.001) compared to nonsmokers during the 5 years in an unadjusted model. However, after propensity-score matching, smokers showed higher risk of MACE (HR, 1.125; 95% CI, 1.009–1.254; p=0.034) and cardiac death (HR, 1.190; 95% CI, 1.026–1.381; p=0.022). Smoking was a strong independent predictor of lung cancer (propensityscore matched HR, 2.749; 95% CI, 1.416–5.338; p=0.003).
Conclusions
In contrast to the unadjusted model, smoking is associated with worse cardiovascular outcome and higher incidence of lung cancer after adjustment of various confounding factors. This result can be explained by the characteristics of smokers, which were young and had fewer comorbidities.

Keyword

Smoking; Myocardial infarction; Percutaneous coronary intervention; Lung cancer

Figure

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  Figure 1 Study flow.

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  Figure 2 Unadjusted and propensity-score adjusted associations of smoking and long-term clinical outcomes.CI = confidence interval; HR = hazard ratio; MACE = major adverse cardiovascular events.

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  Figure 3 Cumulative incidence rate of (A) major adverse cardiovascular events, (B) all-cause death, (C) cardiac death, (D) myocardial infarction, (E) stroke, and (F) any revascularization among propensity-score matched patients.

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  Figure 4 Comparative hazard ratios of major adverse cardiovascular events for subgroups in propensity-score matched patients.CI = confidence interval; HR = hazard ratio; LVEF = left ventricular ejection fraction; NSTEMI = non-ST-segment elevation myocardial infarction; STEMI = ST-segment elevation myocardial infarction.

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