Smoking status and outcome after primary coronary angioplasty for acute myocardial infarction

Background Because of the increased propensity of intracoronary thrombi to form in cigarette smokers, percutaneous transluminal angioplasty (PTCA) for acute myocardial infarction (AMI) may be less effective in smokers. We sou ght to determine the impact of smoking status on outcome after PTCA for AMI . Methods Patients enrolled in the GUSTO IIb Angioplasty Substudy were random ly assigned to receive PTCA or tissue-plasminogen activator (tPA) for AMI. The interaction of smoking status (nonsmokers = 344, Former smokers = 294, current smokers = 490) and treatment strategy with the occurrence of death, nonfatal reinfarction, or nonfatal, disabling stroke at 30 days was analyz ed. Procedural success (residual stenosis <50% and Thrombolysis in Myocardi al Infarction [TIMI] Flow grade 3) was also analyzed for patients who under went PTCA (n = 444). Results Among patients who underwent PTCA, nonsmokers had worse percent ste nosis of the culprit lesion before reperfusion (P = .03) and more often had TIMI flow grade 0 (P < .05). Procedural success was more common in smokers (65.6%) than in former smokers (53.3%) and nonsmokers (52.4%; P = .02), re flecting a higher rate of postprocedure TIMI 3 Flow. PTCA was associated wi th a better 30-day outcome than tPA for current smokers (odds ratio [95% co nfidence interval] = 0.41 [0.19 to 0.88]), with a similar trend for former smokers (0.73 [0.34 to 1.58]) and nonsmokers (0.77 [0.42 to 1.40]). At 6 mo nths, smokers randomly assigned to PTCA also had fewer deaths and reinfarct ion (0.58 [0.31 to 1.07]). Conclusions Although smoking status affects angiographic variables before a nd after PTCA for AMI, PTCA is associated with a better 30-day outcome than tPA regardless of smoking status and should be considered when readily ava ilable.