Journal of Vascular Medicine & Surgery

Abstract

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

Saleh A

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.