Current smoking and prognosis after acute ST-segment elevation myocardial infarction: new pathophysiological insights

Haig, C. et al. (2019) Current smoking and prognosis after acute ST-segment elevation myocardial infarction: new pathophysiological insights. JACC: Cardiovascular Imaging, (doi:10.1016/j.jcmg.2018.05.022) (PMID:30031700) (In Press)

Haig, C. et al. (2019) Current smoking and prognosis after acute ST-segment elevation myocardial infarction: new pathophysiological insights. JACC: Cardiovascular Imaging, (doi:10.1016/j.jcmg.2018.05.022) (PMID:30031700) (In Press)

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Abstract

Objectives: The aim of this study was to mechanistically investigate associations among cigarette smoking, microvascular pathology, and longer term health outcomes in patients with acute ST-segment elevation myocardial infarction (MI). Background: The pathophysiology of myocardial reperfusion injury and prognosis in smokers with acute ST-segment elevation MI is incompletely understood. Methods: Patients were prospectively enrolled during emergency percutaneous coronary intervention. Microvascular function in the culprit artery was measured invasively. Contrast-enhanced magnetic resonance imaging (1.5-T) was performed 2 days and 6 months post-MI. Infarct size and microvascular obstruction were assessed using late gadolinium enhancement imaging. Myocardial hemorrhage was assessed with T2* mapping. Pre-specified endpoints included: 1) all-cause death or first heart failure hospitalization; and 2) cardiac death, nonfatal MI, or urgent coronary revascularization (major adverse cardiovascular events). Binary logistic regression (odds ratio [OR] with 95% confidence interval [CI]) with smoking status was used. Results: In total, 324 patients with ST-segment elevation MI were enrolled (mean age 59 years, 73% men, 60% current smokers). Current smokers were younger (55 ± 11 years vs. 65 ± 10 years, p < 0.001), with fewer patients with hypertension (52 ± 27% vs. 53 ± 41%, p = 0.007). Smokers had better TIMI (Thrombolysis In Myocardial Infarction) flow grade (≥2 vs. ≤1, p = 0.024) and ST-segment resolution (none vs. partial vs. complete, p = 0.010) post–percutaneous coronary intervention. On day 1, smokers had higher circulating C-reactive protein, neutrophil, and monocyte levels. Two days post-MI, smoking independently predicted infarct zone hemorrhage (OR: 2.76; 95% CI: 1.42 to 5.37; p = 0.003). After a median follow-up period of 4 years, smoking independently predicted all-cause death or heart failure events (OR: 2.20; 95% CI: 1.07 to 4.54) and major adverse cardiovascular events (OR: 2.79; 95% CI: 2.30 to 5.99). Conclusions: Smoking is associated with enhanced inflammation acutely, infarct-zone hemorrhage subsequently, and longer term adverse cardiac outcomes. Inflammation and irreversible myocardial hemorrhage post-MI represent mechanistic drivers for adverse long-term prognosis in smokers. (Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction. [BHF MR-MI]; NCT02072850).

Item Type:Articles
Status:In Press
Refereed:Yes
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and Welsh, Dr Paul and Maznyczka, Dr Annette Marie and Carrick, Dr David and Petrie, Professor Mark and Wetherall, Miss Kirsty and Eteiba, Dr Hany and Oldroyd, Dr Keith and Mangion, Dr Kenneth and Haig, Dr Caroline and Carberry, Miss Jaclyn and Sattar, Professor Naveed and Ford, Professor Ian and Mordi, Dr Ify and Radjenovic, Dr Aleksandra and Ahmed, Mr Nadeem and Hood, Dr Stuart
Authors: Haig, C., Carrick, D., Carberry, J., Mangion, K., Maznyczka, A., Wetherall, K., McEntegart, M., Petrie, M. C., Eteiba, H., Lindsay, M., Hood, S., Watkins, S., Davie, A., Mahrous, A., Mordi, I., Ahmed, N., May, V. T. Y., Ford, I., Radjenovic, A., Welsh, P., Sattar, N., Oldroyd, K. G., and Berry, C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:JACC: Cardiovascular Imaging
Publisher:Elsevier
ISSN:1936-878X
ISSN (Online):1876-7591
Published Online:18 July 2018
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in JACC: Cardiovascular Imaging 2018
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
617771BHF centre of excellenceRhian TouyzBritish Heart Foundation (BHF)RE/13/5/30177RI CARDIOVASCULAR & MEDICAL SCIENCES
544551Validation and significance of myocardial haemorrhage revealed by "bright blood" T2-weighted MRI in heart attack survivors: a prospective cohort study.Colin BerryBritish Heart Foundation (BHF)PG/11/2/28474RI CARDIOVASCULAR & MEDICAL SCIENCES
699321Myocardial strain measurements in survivors of acute ST-elevation myocardial infarction: implementation and prognostic significance of novel magnetic resonance imaging methods.Colin BerryBritish Heart Foundation (BHF)FS/15/54/31639RI CARDIOVASCULAR & MEDICAL SCIENCES
744211T-TIME Coronary Physiology StudyColin BerryBritish Heart Foundation (BHF)FS/16/74/32573RI CARDIOVASCULAR & MEDICAL SCIENCES
612031Cardiac biomarkers and CVD risk screening: a cost-effective public health measure?Paul WelshBritish Heart Foundation (BHF)FS/12/62/29889RI CARDIOVASCULAR & MEDICAL SCIENCES