Impact of active smoking on myocardial infarction severity in reperfused ST-segment elevation myocardial infarction patients: the smoker's paradox revisited.

Détails

ID Serval
serval:BIB_3BC576B80ADF
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Impact of active smoking on myocardial infarction severity in reperfused ST-segment elevation myocardial infarction patients: the smoker's paradox revisited.
Périodique
European heart journal
Auteur(s)
Symons R., Masci P.G., Francone M., Claus P., Barison A., Carbone I., Agati L., Galea N., Janssens S., Bogaert J.
ISSN
1522-9645 (Electronic)
ISSN-L
0195-668X
Statut éditorial
Publié
Date de publication
21/09/2016
Peer-reviewed
Oui
Volume
37
Numéro
36
Pages
2756-2764
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Résumé
To investigate the influence of cardiovascular risk factors (CV-RFs) on infarct severity and post-infarction left ventricular (LV) remodelling in acutely reperfused ST-segment elevation myocardial infarction (STEMI) patients studied with cardiovascular magnetic resonance (CMR).
Four-hundred seventy-one patients were included in the study. Baseline CMR was performed at 4 ± 1 days after STEMI to assess area-at-risk, infarct size (IS), myocardial salvage index (MSI), microvascular obstruction (MVO), intramyocardial haemorrhage (IMH), LV volumes, and function. Cardiovascular magnetic resonance was repeated 4 months after STEMI (n = 383) to assess adverse LV remodelling (increase of LV end-diastolic volume >20% between baseline and follow-up). Smoking was associated with IMH at baseline even after correction for other factors associated with ischaemia-reperfusion injury including MVO, IS, and MSI (OR: 2.17, 95% CI: 1.17-4.00, P = 0.01). Unexpectedly, smoking was an independent protective predictor against adverse LV remodelling (OR: 0.43, 95% CI: 0.24-0.77, P = 0.005), consistent with the 'smoker's paradox'. However, the presence of IMH at baseline abolished the paradoxical, beneficial effects of smoking with respect to IS, baseline LV function, and post-infarction LV remodelling. No association between other CV-RFs, infarct severity, or post-infarction LV remodelling was observed.
In patients with reperfused STEMI, smoking is strongly and independently associated with IMH at baseline. Nonetheless, consistent with the 'smoker's paradox', smoking was an independent predictor of more favourable post-infarction LV remodelling. However, the paradoxical beneficial effects of smoking were lost in patients with IMH.

Mots-clé
Humans, Risk Factors, ST Elevation Myocardial Infarction, Smokers, Smoking, Cardiovascular risk factors, Left ventricular remodelling, Myocardial infarction, Smoker's paradox
Pubmed
Web of science
Open Access
Oui
Création de la notice
11/11/2016 10:12
Dernière modification de la notice
20/08/2019 14:31
Données d'usage