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A retrospective cohort study of the association between smoking and mortality after acute ST-segment elevation myocardial infarction
  1. Lloyd Steele1,
  2. Amelia Lloyd1,
  3. James Fotheringham2,
  4. Ayyaz Sultan3,
  5. Javaid Iqbal1,
  6. Ever D Grech3
  1. 1 The University of Sheffield, Sheffield, UK
  2. 2 The School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
  3. 3 The South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, UK
  1. Correspondence to Dr Ever D Grech, South Yorkshire Cardiothoracic Centre, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK; Ever.Grech{at}


Background Several studies have shown a ‘smoker's paradox’, where following an acute myocardial infarction, smokers have a paradoxically lower mortality than non-smokers. To date, no large study has investigated this paradox in unselected patients with acute ST-segment elevation myocardial infarction (STEMI) managed by primary percutaneous coronary intervention (PCI) alone.

Objectives We aimed to examine the association of smoking status and 1-year mortality in patients who had STEMI managed by primary PCI.

Methods This retrospective study included all patients admitted with acute STEMI undergoing primary PCI in a single UK centre from January 2009 to April 2012. The survival status for all patients post-STEMI was obtained. Differences in survival by smoking status were assessed using a Kaplan-Meier curve, and after adjustment for age, gender and additional cardiovascular risk factors using a Cox regression analysis.

Results The 1-year mortality for patients with STEMI was 149/1796 (8.3%). There were 846/1796 (47.1%) current smokers, 476/1796 (26.5%) ex-smokers and 417/1796 (23.2%) never smokers. Current smokers were approximately 10 years younger than ex-smokers and never smokers (p=0.001). A multivariate Cox proportional hazards model found no evidence of an association between mortality and smoking status after adjustment; p=0.23. Compared with never smokers, the HR (95% CI) for 1-year mortality for current smokers was 1.47 (0.90 to 2.39) and 1.08 (0.66 to 1.77) for ex-smokers.

Conclusions In this retrospective cohort study, we found no evidence of an association between mortality and smoking status in patients with acute STEMI treated with PCI, and thus no evidence of a ‘smoker's paradox’.

  • smoking cessation
  • smoking
  • follow-up studies

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  • Contributors All authors were involved in the preparation of the manuscript, have read the manuscript, agree with the analyses of the data and the conclusions reached in the manuscript, and are accountable for all aspects of the work.

  • Competing interests None declared.

  • Ethics approval At the time of study set up, NHS REC approval was not required for research involving previously collected data extracted from hospital records and rendered non-identifiable by the direct care team before being used for research purposes. NHS permission was gained for this study via the Sheffield Teaching Hospitals Research and Development Department to ensure the study's compliance with the Data Protection Act and to protect patient confidentiality.

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

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