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, 12(6), pp. 993-1003. (doi: 10.1016/j.jcmg.2018.05.022) (PMID:30031700) (PMCID:PMC6547246)

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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
Glasgow Author(s) Enlighten ID:Carrick, Dr David and Mangion, Dr Kenneth and Hood, Dr Stuart and Maznyczka, Dr Annette Marie and Eteiba, Dr Hany and Wetherall, Miss Kirsty and Ahmed, Mr Nadeem and Welsh, Dr Paul and Petrie, Professor Mark and Oldroyd, Dr Keith and Carberry, Dr Jaclyn and Ford, Professor Ian and Berry, Professor Colin and Haig, Dr Caroline and Sattar, Professor Naveed and Mordi, Dr Ify and Radjenovic, Dr Aleksandra
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 > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:JACC: Cardiovascular Imaging
ISSN (Online):1876-7591
Published Online:18 July 2018
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in JACC: Cardiovascular Imaging 12(6): 993-1003
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
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