The tobacco paradox in acute coronary syndrome. The prior cessation of smoking as a marker of a better short-term prognosis

• Published in: Revista clínica espanõla (English edition) 2016-08, Vol.216 (6), p.301-307
• Main Authors: Bastos-Amador, P., Almendro-Delia, M., Muñoz-Calero, B., Blanco-Ponce, E., Recio-Mayoral, A., Reina-Toral, A., Cruz-Fernandez, J.M., García-Alcántara, A., Hidalgo-Urbano, R., García-Rubira, J.C.
• Format: Article
• Language: English
• Subjects: Abandono tabaquismo; Acute coronary syndrome; Acute myocardial infarction; Factores de riesgo; Infarto agudo de miocardio; Prognosis; Pronóstico; Risk factors; Smoking; Smoking cessation; Síndrome coronario agudo; Tabaquismo
• ISSN: 2254-8874; 2254-8874
• DOI: 10.1016/j.rceng.2016.03.001

The tobacco paradox is a phenomenon insufficiently explained by previous studies. This study analyses the prognostic role of prior or active smoking in patients with acute coronary syndrome. We obtained data from the ARIAM registry, between 2001 and 2012. The study included 42,827 patients with acute coronary syndrome (mean age, 65±13 years; 26.4% women). The influence of smoking and that of being an ex-smoker on mortality was analysed using a multivariate analysis. The smokers were younger, were more often men, had less diabetes, hypertension and prior history of heart failure, stroke, arrhythmia and renal failure and more frequently had ST-elevation and a family history of smoking. The ex-smokers had more dyslipidaemia and history of angina, myocardial infarction, ischemic heart disease, peripheral vasculopathy and chronic bronchial disease. Smokers and ex-smokers less frequently developed cardiogenic shock (smokers 4.2%, ex-smokers 4.7% and nonsmokers 6.9%, p