JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE) ›› 2020, Vol. 40 ›› Issue (05): 573-582.doi: 10.3969/j.issn.1674-8115.2020.05.003

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Evaluation of effect of smoking on myocardial injury and prognosis in patients with acute ST-segment elevation myocardial infarction

FENG Ze-hao1*, ZHANG Qing1*, CHAI Ye-zi1, SU Xuan1, SUN Bao-hang-xing1, LIU Qi-ming1, YAN Fu-hua2, JIANG Meng1#, PU Jun1#   

  1. 1. Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; 2. Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Online:2020-05-28 Published:2020-05-28
  • Supported by:
    National Natural Science Foundation of China (81971570); Shanghai ShenKang Hospital Development Center Three-year Action Plan: Promoting Clinical Skills and Innovation in Municipal Hospital (16CR3020A); Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support (20172014); Shanghai Pudong Health and Family Planning Commission Joint Research Project (PW2018D-03); Medical-Engineering Cross Research Foundation of Shanghai Jiao Tong University (YG2019ZDA13); Innovative Research Team of High-Level Local Universities in Shanghai (SSMU-ZDCX20180200).

Abstract: Objective · To investigate the influence of smoking on acute myocardial injury and long-term prognosis in the patients with ST-segment elevation myocardial infraction (STEMI) by cardiac magnetic resonance (CMR). Methods · Three hundred and forty-nine STEMI patients were retrospectively selected from a prospective cohort from May 2012 to August 2017, and were followed up for at least 2 years. The primary endpoint was a composite of all-cause death, reinfarction and stroke. The secondary endpoint was heart failure rehospitalization. The patients were divided into smoker group and non-smoker group according to the baseline status of smoking which was recorded at admission. The difference in the incidence of endpoint events was further analyzed in combination with the presence or absence of intramyocardial hemorrhage (IMH) between the two groups. Results · There were 221 patients in the smoker group, accounting for 63.3% of the total sample. The average age of onset in smokers were 4.66 years earlier than non-smokers. However, smokers showed a lower incidence of left ventricular thrombosis and lower levels of brain natriuretic peptide than non-smokers (P=0.023, P=0.000). There was no difference in the left ventricular ejection fraction between the two groups (P>0.05), but the smokers had a better end-systolic and end-diastolic volume index (P=0.019, P=0.007). Smokers and non-smokers had similar clinical outcomes of all-cause death, reinfarction and stroke (P>0.05). The incidence of heart failure rehospitalization in smokers was quite lower than that of the non-smokers, but this kind of protective effect disappeared after differences in baseline being adjusted (P=0.167). In the patients with IMH, smoking had a protective effect on primary endpoints (HR=0.266, P=0.008), but in the patients without IMH, smokers had a worse outcome of all-cause death and reinfarction than non-smokers (P=0.024). Conclusion · In patients with STEMI, smoking has no protective effect on long-term prognosis. When IMH appears in STEMI patients, smoking has a protective effect on all-cause death, reinfarction and stoke. However, in patients without IMH, smokers have a worse prognosis than non-smokers.

Key words: smoker's paradox, intramyocardial hemorrhage (IMH), cardiac magnetic resonance (CMR), ST-segment elevation myocardial infarction (STEMI)

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