In-hospital mortality of habitual cigarette smokers after acute myocardialinfarction - The 'smoker's paradox' in a countrywide study

Aims Habitual cigarette smokers, paradoxically, present improved short-term prognosis after acute myocardial infarction, a phenomenon often termed 'sm oker's paradox'. We sought to examine cigarette smokers' post-infarction su rvival advantage in a countrywide survey of unselected, consecutive patient s presenting with acute myocardial infarction. Methods and Results The study population was derived from the registry of t he Hellenic study of acute myocardial infarction, which recruited 7433 cons ecutive patients with acute myocardial infarction from 76, out of a total o f 86, hospitals countrywide. Cigarette smokers presented with lower unadjus ted mortality rates (7.4% vs 14.5%,, P<0.001), were younger, predominantly of male gender and were less likely to suffer from diabetes mellitus and ar terial hypertension. When all univariate predictors of poor outcome were in cluded as covariates in multivariate analysis, smoking status was not signi ficantly associated with inhospital mortality (relative risk = 1.12. 95% CI =0.86 1.44, P=0.399). The beneficial effect of thrombolytic therapy was ind ependent of the smoking status ill both univariate and multivariate analysi s. Conclusion Unadjusted mortality rates are significantly lower in smokers, b ut age accounted for much of their seemingly improved outcome. When a numbe r of additional clinical variables were taken into consideration, no signif icant influence of habitual smoking on early outcome following acute myocar dial infarction was observed. (Eur Heart. J 2001; 22: 776-784, doi: 10053/e uhj.2000.2315) (C) 2001 The European Society of Cardiology.