Revision of the "smoker's paradox": Smoking is not a good prognostic factor immediately after myocardial infarction.

In order to determine the reasons for the low mortality after myocardial in farction in smokers compared with non-smokers (the smoker's paradox), the a uthors analysed the initial clinical data, the therapeutic interventions an d hospital mortality in 790 consecutive patients (555 smokers, 235 non-smok ers) admitted to hospital within 6 hours of the first symptoms of acute myo cardial infarction and treated by intravenous thrombolytic agents and/or co ronary angioplasty. Multivariate analysis with linear regression was used to identify the predi ctive factors of hospital mortality. The main differences between smokers a nd non-smokers were age (56 vs 67 years, p < 0.0001), gender (male, 90 vs 6 0%, p < 0.01), cardiogenic shock on admission (3 vs 8%, p < 0.01). TIMI 3 f low was obtained in the culprit artery in 84% of smokers and 79% of non-smo kers (NS). Hospital mortality was 5% in the smoking population and 16% in n on-smokers (p < 0.0001). In multivariate analysis, the variables of cardiog enic shock, age, gender and hypertension provided most of the prognostic in formation and tobacco consumption did not appear to have a protective effec t. In patients admitted to hospital with acute myocardial infarction, identica l incidences of early reperfusion are obtained in smokers and in non-smoker s. However, mortality is higher in the non-smoking group due to more severe clinical characteristics on admission. Tobacco consumption is not a protec tive factor in the immediate period after acute myocardial infarction.