The "smoker's paradox" in patients with acute coronary syndrome: a systematic review

Aune, Erlend; Røislien, Jo; Mathisen, Mariann; Thelle, Dag S.; Otterstad, Jan Erik

doi:10.1186/1741-7015-9-97

Cited by 133 publications

(101 citation statements)

References 36 publications

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“…[20][21][22] The overall rate of smoking (21%) reported in this study is similar to previously published studies when adjusted for age. 23,24 As expected, smoking was associated with younger age, lower serum glucose levels, 6 and lower rates of atrial fibrillation. 25 These baseline differences may explain the slightly lower NIHSS scores observed in patients with this risk factor, which may have contributed to the improved 3-month outcome.…”

Section: Discussionmentioning

confidence: 74%

Smoking-Thrombolysis Paradox

Kufner

Nolte²,

Galinović³

et al. 2013

Stroke

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Background and Purpose— The so-called smoking-thrombolysis paradox of an improved outcome after thrombolysis was first described in smokers with myocardial infarction. We investigated whether reperfusion rates and clinical outcome differ between smokers and nonsmokers with ischemic stroke after intravenous tissue plasminogen activator. Methods— Consecutive acute ischemic stroke patients, who had magnetic resonance imaging before and 1 day after thrombolysis, were included for analysis. All of the patients received intravenous tissue plasminogen activator within 4.5 hours. Reperfusion was defined as a 75% reduction in perfusion deficit (mean transit time >6 s) after thrombolysis compared with baseline. Magnetic resonance angiography was used to evaluate arterial stenosis and occlusion. Functional outcome was assessed 3 months after stroke using the modified Rankin Score. Results— Of 148 patients, 21.6% were smokers (n=32). Smokers were younger (median, 61 years [ SD , 9.4 years] versus 75 years [ SD , 11.6 years]; P <0.001), less often women (28% versus 51%; P =0.03), had lower baseline glucose levels (median, 6.2 mmol/L [interquartile range, 5.7–6.8 mmol/L] versus 6.7 mmol/L [interquartile range, 6.1–8.2 mmol/L]; P <0.01) and higher baseline perfusion deficits (median, 53 mL [interquartile range, 13–141 mL] versus 17 mL [interquartile range, 2–66 mL]; P =0.04). In a backward stepwise regression analysis including age, sex, hypertension, glucose, perfusion deficit, and smoking, smoking had an odds ratio of 4 (95% confidence interval, 1–16; P =0.03) for reperfusion and 6 (95% confidence interval, 1–30; P =0.05) for recanalization (regression analysis for recanalization also included localization of arterial occlusion). Smokers had a better outcome (modified Rankin Score=0–2) than nonsmokers (77% versus 55%; P =0.05). Conclusions— Smoking is independently associated with recanalization and reperfusion, indicating that thrombolytic therapy acts more effectively in smokers; because of small numbers, these results should be considered preliminary. Clinical Trial Registration— URL: http://clinicaltrials.gov . Unique Identifier: NCT00715533.

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Section: Discussionmentioning

confidence: 74%

Smoking-Thrombolysis Paradox

Kufner

Nolte²,

Galinović³

et al. 2013

Stroke

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“…It is known for its role in impairing endogenous fibrinolysis, enhancing platelet aggregation and thrombus formation, and promoting the development of a thin fibrous cap in atherosclerotic coronary plaques, thus predisposing the plaque to erosion and subsequent thrombosis leading to acute coronary syndrome (ACS) [4][5][6][7]. However, various studies have shown that smokers have lower mortality rates following ACS than non-smokers, suggesting that smoking has a protective effect in ACS giving rise to the concept of the "smoker's paradox", in which smokers are more likely to suffer ACS but also more likely to survive [8][9][10]. Subsequently, various studies have demonstrated that smokers tended to be younger, with fewer comorbidities, and less extensive coronary disease.…”

Section: Introductionmentioning

confidence: 99%

Absence of Smoker’s Paradox in Middle Eastern Patients with Acute Coronary Syndrome

Saleh¹

2016

Vasc Med Surg

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Studies have shown that smokers admitted with acute coronary syndrome (ACS) have an apparent lower inhospital and long term mortality rates compared with nonsmokers ("smoker's paradox"). This study was done to test if the "smoker's paradox" exists in Middle Eastern ACS patients. A 1618 consecutive patients admitted with acute coronary syndrome in 4 tertiary hospitals were enrolled. We compared clinical and coronary angiographic features and mortality during admission and after one year among smokers vs. non-smokers. Of the whole group (N=1618); smokers (N=859; 53%) were younger than non-smokers (Mean age 50+7 vs. 63+9 year; P=0.005), more likely to be male (96% vs. 69%; P<0.001), and less likely to have hypertension (33% vs. 67%; P<0.001) and diabetes mellitus (29% vs. 50%; P<0.001). Smokers were more likely to have ST-segment elevation myocardial infarction (STEMI) than non-smokers (35% vs. 24%; P<0.001) and less likely to have non ST-segment elevation ACS (65% vs. 76%; P=0.005). Compared with non-smokers; smokers had similar incidence of anterior wall MI (51.7% vs. 53.9%; P=NS), higher incidence of single vessel disease (54% vs. 47%; P=0.002) and lower incidence of multi vessel disease (44% vs. 51%; P=0.005). There were no statistically significant differences between the in-hospital (3.2% vs. 2.2%; =0.29) and 1-year (6.5% vs. 7.0%; P=0.92) mortality rates in smoker sand non-smokers; respectively. Despite being younger with less prevalence of comorbid diseases, multivessel coronary artery disease, and low TIMI risk scores; smokers in the Middle East with ACS did not have a better in-hospital or 1 year out come compared with nonsmokers.

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“…6 Also, industrial and household smoke could cause oxidative stress, which would go on to induce hyperviscosity. [7][8][9] Therefore, there is an obvious need to develop a unified approach for assessment of cigarette toxicity, especially for non-smokers, because this group is exposed to second-hand smoke and also third-hand smoke that is the accumulation of first-hand smoke over a period becoming more toxic in the process.…”

Section: Introductionmentioning

confidence: 99%