Smoking and infarct size among STEMI patients undergoing primary angioplasty

Background: Prior studies have found that smokers with STEMI have lower mortality rates and a more favorable response to fibrinolytic therapy than nonsmokers, phenomenon defined as the smoker's paradox. Still poorly explored is the impact of cigarette smoking in patients undergoing primary percutaneous coronary intervention. Aim of the current study was to evaluate the impact of cigarette smoking on scintigraphic infarct size in STEMI patients undergoing primary PCI. Methods: Our population is represented by 830 STEMI patients undergoing primary PCI. Infarct size was evaluated at 30 days by technetium-99m-sestamibi. Results: Smoking was associated with younger age (p<0.001), a lower prevalence of female gender (p<0.001), hypertension (p<0.001), diabetes (p=0.003), shorter ischemia time (p=0.037), but higher rates of previous PCI (p=0.016). No differences were observed in other clinical or angiographic characteristics. In particular, smoking did not affect the rate of postprocedural TIMI 3 flow. As shown in Fig.1, smoking did not affect infarct size (12.5% [3.3%-23.7%] vs 12.7% [4.9%-25.9%], p=0.12). Similar results were observed in subanalyses according to infarct location (anterior STEMI, p int=0.33), gender (p int=0.95) age, (p Int=0.96), diabetes (p int=0.85). The absence of any impact of smoking on infarct size was confirmed after correction for baseline characteristics, such as age, gender, hypertension, diabetes, previous PCI, ischemia time (OR [95% CI]=0.80 [0.59-1.09], p=0.15). Conclusions: This study shows that among STEMI patients undergoing primary PCI smoking status does not affect infarct size.