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The Impact of Smoking Status 1 Year After ST-Segment Elevation Myocardial Infarction on Cardiovascular Events and
Amir Aker1, Walid Saliba2, Shani Schnaider3
1Department of Cardiology, Lady Davis Carmel Medical Center, Haifa, Israel.
Insights
Continuing to smoke after a heart attack significantly increases the risk of major adverse cardiovascular events (MACEs) and death. Quitting smoking post-STEMI (ST-elevation myocardial infarction) leads to outcomes comparable to non-smokers.
Area of Science:
- Cardiology
- Public Health
Background:
- Smoking is a major risk factor for ST-elevation myocardial infarction (STEMI), particularly in younger individuals.
- Smoking cessation rates after STEMI are often suboptimal, despite smoking being a modifiable risk factor.
Purpose of the Study:
- To investigate the association between smoking status one year after STEMI and adverse cardiovascular events in patients aged 60 years or younger.
- To compare the long-term outcomes of patients who continued smoking versus those who quit after experiencing STEMI.
Main Methods:
- A cohort of 765 patients (≤60 years) presenting with STEMI were categorized into nonsmokers, quitters, and continued/resumed smokers one year post-event.
- Major adverse cardiovascular events (MACEs), including myocardial infarction, stroke, unstable angina, and death, were analyzed over a median follow-up of 8 years.
Main Results:
- Continued smoking after STEMI was associated with significantly higher adjusted hazard ratios for MACEs (2.40), myocardial infarction (2.51), and death (2.52) compared to nonsmokers.
- Patients who quit smoking after STEMI did not show a significantly increased risk for MACEs (HR 1.20) or individual adverse events compared to nonsmokers.
- The prevalence of smoking among young and middle-aged STEMI patients was high (56%), with low cessation rates observed one year post-event.
Conclusions:
- Continued smoking post-STEMI is linked to substantially worse cardiovascular outcomes and increased mortality.
- Quitting smoking after STEMI offers significant cardiovascular protection, with long-term outcomes comparable to those who never smoked.
- The findings underscore a critical gap between the proven benefits of smoking cessation and low abstinence rates in clinical practice following STEMI.
Abstract:
Smoking is associated with increased risk for acute ST-elevation myocardial infarction (STEMI) at a young age. Although smoking is a modifiable risk factor, smoking cessation rates after STEMI are suboptimal. We investigated the association between smoking status 1 year after STEMI and adverse events in patients (n = 765) aged ≤60 years. Patients were categorized as: (1) nonsmokers, (2) quit smoking, and (3) continued/resumed smoking. The association between smoking status and risk for major adverse cardiovascular events (MACEs) was analyzed during a median follow-up of 8 years. At presentation with STEMI, the mean age was 51 ± 7 years (88% men) and 427 (56%) were smokers. A year after STEMI, 272 continued smoking, 35 quit but later resumed smoking (summed to a single group; n = 307), and 120 quit smoking. Continued smoking was associated with younger age, male gender, lower weight, and low socioeconomic status. Compared with nonsmokers, the adjusted hazard ratio (95% confidence interval) for myocardial infarction, stroke, unstable angina, death, and MACE was 2.51 (1.67 to 3.73), 2.07 (0.94 to 4.56), 3.73 (1.84 to 7.58), 2.52 (1.53 to 4.13), and 2.40 (1.80 to 3.22), accordingly, in those who continued to smoke. However, the adjusted hazard ratio was not significantly associated with these outcomes in patients who quit smoking (MACE: 1.20 [0.77 to 1.87], p=0.414; nonsignificant for individual end points). In conclusion, the prevalence of smoking in young and middle-aged patients presenting with STEMI is high and smoking cessation rates are low. A year after STEMI, those who continued to smoke had worse cardiovascular outcomes and death compared with nonsmokers; however, the long-term outcomes among those who quit smoking appear to be comparable with nonsmokers. The results highlight the contrast between health benefits of quitting smoking after STEMI and low abstinence rates in clinical practice.
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