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Tobacco modalities used and outcome in patients with acute coronary syndrome: an observational report
  1. Jassim Al Suwaidi1,
  2. Khalid Al Habib2,
  3. Rajvir Singh3,
  4. Ahmad Hersi2,
  5. Khalid Al Nemer4,
  6. Nidal Asaad1,
  7. Shukri Al Saif5,
  8. Ahmed Al-Motarreb6,
  9. Wael Almahmeed7,
  10. Kadhim Sulaiman8,
  11. Haitham Amin9,
  12. Jawad Al-Lawati10,
  13. Nizar Al Bustani7,
  14. Norah Q Al-Sagheer11,
  15. Waleed M Ali1
  1. 1Department of Cardiology, Hamad Medical Corporation (HMC), Qatar
  2. 2King Fahad Cardiac Center, King Khalid University Hospital, College of Medicine, Riyadh, Saudi Arabia
  3. 3Department of Research, Hamad Medical Corporation (HMC), Qatar
  4. 4Security Forces Hospital, Riyadh, Saudi Arabia
  5. 5Saud Al Babtain Cardiac Center, Dammam, Saudi Arabia
  6. 6Faculty of Medicine, Sana's University, Sana'a, Yemen
  7. 7Department of Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
  8. 8Department of Cardiology, Royal Hospital, Muscat, Oman
  9. 9Mohammed Bin Khalifa Cardiac Center, Bahrain
  10. 10Department of Non-Communicable Diseases Surveillance and Control, Ministry of Health Muscat, Oman
  11. 11Cardiac Center, Al-Thawra Hospital, Sana'a, Yemen
  1. Correspondence to Dr Jassim Al Suwaidi, Department of Adult Cardiology, Heart Hospital, Hamad Medical Corporation (HMC), P.O Box 3050, Doha, Qatar; jalsuwaidi{at}


Aim The authors evaluated the prevalence and effect of the various tobacco use modalities among patients presenting with acute coronary syndrome (ACS) and compared them with non-tobacco and ex-tobacco users.

Methods An analysis of the 2nd Gulf Registry of Acute Coronary Events conducted between October 2008 and June 2009 and which included 7930 consecutive patients hospitalised with ACS was made. Patients initially were divided into non-tobacco users, ex-tobacco users and current tobacco users. Subanalysis according to the tobacco modality used was subsequently made: cigarette, waterpipe or smokeless tobacco users.

Results Overall, 2834 (36%) patients were current tobacco users, 306 (3.9%) patients were waterpipe smokers and 240 patients (3%) were oral tobacco users. When compared with non-tobacco and ex-tobacco users, overall current tobacco users were younger, more likely to be male subjects and less likely to have diabetes mellitus, hypertension and dyslipidaemia. Mortality rate (p=0.001) and overall cardiovascular events (p=0.001) were lower among current tobacco users when compared with the other two groups. After adjustment for baseline variables, tobacco use was not an independent predictor of adverse events. Subset analysis demonstrates oral tobacco users and waterpipe smokers were older and more likely to be women when compared with cigarette smokers. Among the various tobacco groups, inhospital mortality rates were significantly higher among the waterpipe smokers when compared with the other two groups.

Conclusions Clinical characteristics and outcomes of ACS patients depend on the tobacco modality used. Further studies are required to evaluate the impact of emerging tobacco use modalities on patients with coronary artery disease.

  • Acute coronary syndrome
  • ST-elevation myocardial infarction
  • non-ST elevation myocardial infarction
  • cigarette smoking
  • waterpipe smoking
  • smokeless tobacco
  • adult cardiology
  • coronary heart disease
  • myocardial infarction
  • ischaemic heart disease
  • public health
  • cardiology
  • anaesthesia in cardiology
  • audit
  • physiology
  • diabetes and endocrinology

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  • Funding Gulf RACE is a Gulf Heart Association (GHA) project and was financially supported by the GHA, Sanofi Aventis and the College of Medicine Research Center at King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. The sponsors had no role in the study design, data collection, data analysis, writing of the report or submission of the manuscript. The study obtained ethical approvals prior to the study.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Institutional Review Board of each participating hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.