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Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
10:03

Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty

Published on: January 28, 2020

Smoking status and outcome after primary coronary angioplasty for acute myocardial infarction

D Hasdai1, A Lerman, C S Rihal

  • 1Mayo Clinic and Foundation, Rochester, MN, USA.

American Heart Journal
|March 31, 1999
PubMed

Insights

Percutaneous transluminal angioplasty (PTCA) for acute myocardial infarction (AMI) shows better outcomes than tissue-plasminogen activator (tPA) in smokers. This holds true regardless of smoking status, indicating PTCA

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Public Health

Background:

  • Smokers have a higher risk of intracoronary thrombi, potentially impacting percutaneous transluminal angioplasty (PTCA) effectiveness for acute myocardial infarction (AMI).
  • Investigating the influence of smoking status on PTCA outcomes in AMI patients is crucial for optimizing treatment strategies.

Purpose of the Study:

  • To determine the impact of smoking status on procedural success and clinical outcomes following PTCA for AMI.
  • To compare the efficacy of PTCA versus tissue-plasminogen activator (tPA) in patients with AMI across different smoking groups.

Main Methods:

  • Analysis of data from the GUSTO IIb Angioplasty Substudy, randomly assigning patients to PTCA or tPA for AMI.
  • Evaluation of the interaction between smoking status (current, former, nonsmokers) and treatment strategy on 30-day outcomes (death, nonfatal reinfarction, disabling stroke).
  • Assessment of procedural success, defined as <50% residual stenosis and Thrombolysis in Myocardial Infarction (TIMI) flow grade 3, in patients undergoing PTCA.

Main Results:

  • Current smokers undergoing PTCA exhibited a higher procedural success rate (65.6%) compared to former smokers (53.3%) and nonsmokers (52.4%).
  • PTCA demonstrated a better 30-day outcome than tPA for current smokers (OR 0.41 [0.19-0.88]), with similar trends observed in former and nonsmokers.
  • At 6 months, smokers treated with PTCA experienced fewer deaths and reinfarctions compared to tPA (OR 0.58 [0.31-1.07]).

Conclusions:

  • Smoking status influences angiographic variables before and after PTCA in AMI patients.
  • PTCA is associated with superior 30-day outcomes compared to tPA, irrespective of smoking status.
  • PTCA should be considered a viable treatment option for AMI when readily available, regardless of patient smoking history.
Abstract

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