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. 2023 Oct 27:11:20503121231206932.
doi: 10.1177/20503121231206932. eCollection 2023.

Unfolding the reality of the smoking paradox in a South Asian cohort of patients presenting with ST-elevation acute coronary syndrome undergoing primary percutaneous coronary intervention

Rajesh Kumar  1 , Abdul Hakeem Shaikh  1 , Rameez Ahmed  1 , Maria Noor Siddiqui  1 , Kubbra Rahooja  1 , Kalsoom Chachar  1 , Muhammad Qasim Khan  1 , Maryam Samad  1 , Abiha Urooj  1 , Ali Bin Naseer  1 , Jawaid Akbar Sial  1 , Tahir Saghir  1 , Sohail Khan  1 , Nadeem Qamar  1
Affiliations

Unfolding the reality of the smoking paradox in a South Asian cohort of patients presenting with ST-elevation acute coronary syndrome undergoing primary percutaneous coronary intervention

Rajesh Kumar et al. SAGE Open Med. .

Abstract

Objectives: Smoking is a potent risk factor for coronary artery disease, but there is controversy about its protective nature in terms of prognosis in ST-elevation acute coronary syndrome patients undergoing primary percutaneous coronary intervention. So, the main objective of this study is to unfold this controversy in a South Asian population in terms of clinical angiographic parameters and its in-hospital outcomes.

Methods: In this study, we included 1756 consecutive patients diagnosed with ST-elevation acute coronary syndrome undergoing primary percutaneous coronary intervention. Patients were classified into smokers and non-smokers, and the in-hospital mortality rate was compared. Multivariable logistic regression analysis was performed to evaluate the paradoxical role of smoking.

Results: Smokers were younger (53.78 ± 11.16 years vs 56.43 ± 11.17 years; p < 0.001) and more frequently men (98.7% vs 69.9%; p < 0.001) and had less diabetes (19.6% vs 44.8%; p < 0.001) and hypertension (38.5% vs 64.9%; p < 0.001). Smokers presented less frequently in Killip III (5.6% vs 8.1%; p < 0.001) and Killip IV (2.5% vs 4.8%; p < 0.001). Smokers mostly had single vessel disease (41.7% vs 34.4%; p = 0.013), whereas non-smokers had the multi-vessel disease and frequently presented with total occlusion of the culprit vessel (64.6% vs 58.8%; p = 0.040). Smokers have significantly lesser mortality (1.8% vs 4.3%; p = 0.009) compared to non-smokers with an odds ratio of 0.41 (95% confidence interval (CI): 0.21-0.82, p = 0.011); however, adjusted odds ratio on multivariable analysis was 0.67 (95% CI: 0.31-1.41, p = 0.290).

Conclusions: The paradoxical protective role of smoking is the confounding effect of mainly younger age, less coronary artery disease burden, lower prevalence of diabetes and hypertension, and lower Killip III/IV at presentation.

Keywords: STE-ACS; South Asian; primary PCI; smoking paradox.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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References

    1. Papazisis A, Koreli A, Misouridou E. Heavy smoking is associated with low depression and stress: a smokers’ paradox in cardiovascular disease? Mater Sociomed 2019; 31(4): 268–272. - PMC - PubMed
    1. Ramotowski B, Gurbel PA, Tantry U, et al.. Smoking and cardiovascular diseases: paradox greater than expected? Pol Arch Intern Med 2019; 129(10): 700–706. - PubMed
    1. Saad M, Fuernau G, Desch S, et al.. “Smoker’s paradox” in patients with cardiogenic shock complicating myocardial infarction—a substudy of the IABP-SHOCK II-trial and registry. Int J Cardiol 2016; 222: 775–779. - PubMed
    1. Stokes A, Preston SH. Smoking and reverse causation create an obesity paradox in cardiovascular disease. Obesity (Silver Spring) 2015; 23(12): 2485–2490. - PMC - PubMed
    1. Venkatason P, Salleh NM, Zubairi Y, et al.. The bizzare phenomenon of smokers’ paradox in the immediate outcome post acute myocardial infarction: an insight into the Malaysian National Cardiovascular Database-Acute Coronary Syndrome (NCVD-ACS) registry year 2006–2013. Springerplus 2016; 5: 534. - PMC - PubMed