ORIGINAL RESEARCH
Smoker’s Paradox in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention Tanush Gupta, MD; Dhaval Kolte, MD, PhD; Sahil Khera, MD; Prakash Harikrishnan, MD; Marjan Mujib, MD, MPH; Wilbert S. Aronow, MD; Diwakar Jain, MD; Ali Ahmed, MD, MPH; Howard A. Cooper, MD; William H. Frishman, MD; Deepak L. Bhatt, MD, MPH; Gregg C. Fonarow, MD; Julio A. Panza, MD
Background-—Prior studies have found that smokers undergoing thrombolytic therapy for ST-segment elevation myocardial infarction have lower in-hospital mortality than nonsmokers, a phenomenon called the “smoker’s paradox.” Evidence, however, has been conflicting regarding whether this paradoxical association persists in the era of primary percutaneous coronary intervention. Methods and Results-—We used the 2003–2012 National Inpatient Sample databases to identify all patients aged ≥18 years who underwent primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Multivariable logistic regression was used to compare in-hospital mortality between smokers (current and former) and nonsmokers. Of the 985 174 patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention, 438 954 (44.6%) were smokers. Smokers were younger, were more often men, and were less likely to have traditional vascular risk factors than nonsmokers. Smokers had lower observed in-hospital mortality compared with nonsmokers (2.0% versus 5.9%; unadjusted odds ratio 0.32, 95% CI 0.31–0.33, P
Smoker’s Paradox in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention Tanush Gupta, MD; Dhaval Kolte, MD, PhD; Sahil Khera, MD; Prakash Harikrishnan, MD; Marjan Mujib, MD, MPH; Wilbert S. Aronow, MD; Diwakar Jain, MD; Ali Ahmed, MD, MPH; Howard A. Cooper, MD; William H. Frishman, MD; Deepak L. Bhatt, MD, MPH; Gregg C. Fonarow, MD; Julio A. Panza, MD
Background-—Prior studies have found that smokers undergoing thrombolytic therapy for ST-segment elevation myocardial infarction have lower in-hospital mortality than nonsmokers, a phenomenon called the “smoker’s paradox.” Evidence, however, has been conflicting regarding whether this paradoxical association persists in the era of primary percutaneous coronary intervention. Methods and Results-—We used the 2003–2012 National Inpatient Sample databases to identify all patients aged ≥18 years who underwent primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Multivariable logistic regression was used to compare in-hospital mortality between smokers (current and former) and nonsmokers. Of the 985 174 patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention, 438 954 (44.6%) were smokers. Smokers were younger, were more often men, and were less likely to have traditional vascular risk factors than nonsmokers. Smokers had lower observed in-hospital mortality compared with nonsmokers (2.0% versus 5.9%; unadjusted odds ratio 0.32, 95% CI 0.31–0.33, P
