DO ARRHYTHMIAS AFTER INFARCTION DETER PAT IENTS FROM SMOKING

Although the short-term outcome of patients treated by thrombolysis du ring the acute phase of myocardial infarction is now well known, data concerning the repercussions of the coronary accident on smoking are l ess clearly established. This aspect is particularly important, as ces sation of smoking is one of the most effective measures in the context of secondary prevention, with an excellent cost-benefit ratio. Betwee n 1985 and 1991, 218 consecutive patients underwent thrombolysis for m yocardial infarction. With a follow-up of 35 +/- 20 months, 11.5% of p atients have died, including 6% while in hospital. A questionnaire was sent to 193 surviving patients with a response rate of 97.4%. 27.3% o f patients continued to smoke after the myocardial infarction. Smoking patients were younger (p=0.001) and had generally returned to work (p =0.05). Continuation of smoking was not influenced by either the paten cy of the artery or the type of revascularization, and was not correla ted with residual symptoms. The frequency of arrhythmias during the ac ute phase was not related to previous smoking. On the other hand, smok ing patients who survived after an infarction appear to quit smoking t wice as frequently when they had experienced a cardiac arrhythmia duri ng the acute phase of the infarction (p=0.005), as confirmed by multiv ariate analysis. Can the ''stress'' induced by the arrhythmia, possibl y combined with the doctor's reactive anxiety explain cessation of smo king in these patients? If so, it would open new horizons in terms of secondary prevention of myocardial infarction.