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Smoking status and outcome after primary coronary angioplasty for acute myocardial infarction
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.
Background:
Because of the increased propensity of intracoronary thrombi to form in cigarette smokers, percutaneous transluminal angioplasty (PTCA) for acute myocardial infarction (AMI) may be less effective in smokers. We sought to determine the impact of smoking status on outcome after PTCA for AMI.
Methods:
Patients enrolled in the GUSTO IIb Angioplasty Substudy were randomly assigned to receive PTCA or tissue-plasminogen activator (tPA) for AMI. The interaction of smoking status (nonsmokers = 344, former smokers = 294, current smokers = 490) and treatment strategy with the occurrence of death, nonfatal reinfarction, or nonfatal, disabling stroke at 30 days was analyzed. Procedural success (residual stenosis <50% and Thrombolysis in Myocardial Infarction [TIMI] flow grade 3) was also analyzed for patients who underwent PTCA (n = 444).
Results:
Among patients who underwent PTCA, nonsmokers had worse percent stenosis of the culprit lesion before reperfusion (P =.03) and more often had TIMI flow grade 0 (P <.05). Procedural success was more common in smokers (65.6%) than in former smokers (53.3%) and nonsmokers (52. 4%; P =.02), reflecting a higher rate of postprocedure TIMI 3 flow. PTCA was associated with a better 30-day outcome than tPA for current smokers (odds ratio [95% confidence interval] = 0.41 [0.19 to 0.88]), with a similar trend for former smokers (0.73 [0.34 to 1. 58]) and nonsmokers (0.77 [0.42 to 1.40]). At 6 months, smokers randomly assigned to PTCA also had fewer deaths and reinfarction (0. 58 [0.31 to 1.07]).
Conclusions:
Although smoking status affects angiographic variables before and after PTCA for AMI, PTCA is associated with a better 30-day outcome than tPA regardless of smoking status and should be considered when readily available.