[Smoking paradox in acute coronary syndrome without ST-segment elevation]
Almudena Amor-Salamanca1, Carolina Devesa-Cordero, Armando Cuesta-Díaz
1Unidad de Críticos Cardiovasculares, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
Medicina Clinica
|December 15, 2010
Summary
The "smoking paradox" was observed in patients with non-ST-elevation acute coronary syndrome (NST-ACS). Smokers had better outcomes, explained by fewer prior heart attacks and less severe disease, highlighting the need to quit smoking.
Area of Science:
- Cardiology
- Clinical Medicine
- Public Health
Context:
- Smoking is a known cardiovascular risk factor.
- A
- smoking paradox
- has been observed in myocardial infarction patients, indicating better prognosis for smokers.
- The prevalence and implications of this paradox in non-ST-elevation acute coronary syndrome (NST-ACS) require investigation.
Purpose:
- To investigate the
- smoking paradox
- in patients admitted with NST-ACS.
- To identify factors contributing to this phenomenon in the NST-ACS population.
Summary:
- A study of 563 NST-ACS patients revealed smokers (27.53%) were younger, more male, had fewer risk factors, and presented with Killip Class I more often.
- Smokers experienced significantly fewer in-hospital deaths, reinfarctions, or Killip Class IV events (6.5% vs. 13.6%).
- This improved prognosis in smokers was attributed to a lower prevalence of prior myocardial infarction, diabetes, and multivessel disease, though the association was lost after logistic regression adjustment.
Impact:
- The study confirms the
- smoking paradox
- in NST-ACS patients.
- Factors explaining the paradox include lower rates of previous myocardial infarction, diabetes, and multivessel disease among smokers.
- Despite the paradox, quitting smoking remains crucial for cardiovascular health.
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