Influence of cigarette smoking on rate of reopening of the infarct-related coronary artery after myocardial infarction: a multivariate analysis.

Abstract

OBJECTIVES:

This study sought to determine whether the reopening of the infarct-related vessel is related to clinical characteristics or cardiovascular risk factors, or both.

BACKGROUND:

In acute myocardial infarction, thrombolytic therapy reduces mortality by restoring the patency of the infarct-related vessel. However, despite the use of thrombolytic agents, the infarct-related vessel remains occluded in up to 40% of patients.

METHODS:

We studied 295 consecutive patients with an acute myocardial infarction who underwent coronary angiography within 15 days (mean [+/- SD] 6.7 +/- 3.2 days) of the onset of symptoms. Infarct-related artery patency was defined by Thrombolysis in Myocardial Infarction trial flow grade > or = 2. Four cardiovascular risk factors--smoking, hypertension, hypercholesterolemia and diabetes mellitus--and eight different variables-age, gender, in-hospital death, history of previous myocardial infarction, location of current myocardial infarction, use of thrombolytic agents, time interval between onset of symptoms, thrombolytic therapy and coronary angiography--were recorded in all patients.

RESULTS:

Thrombolysis in current smokers and anterior infard location on admission were the three independent factors highly correlated with the patency of the infarct-related vessel (odds ratios 3.2, 3.0 and 1.9, respectively). In smokers, thrombolytic therapy was associated with a higher reopening rate of the infard vessel, from 35% to 77% (p < 0.001). Nonsmokers did not benefit from thrombolytic therapy, regardless of infarct location.

CONCLUSIONS:

These observational data, if replicated, suggest that in patients with acute myocardial infarction, thrombolytic therapy may be most effective in current smokers, whereas nonsmokers and ex-smokers may require other management strategies, such as emergency percutaneous transluminal coronary angioplasty.

• Authors: C de Chillou, P Riff, N Sadoul, G Ethevenot, L Feldmann, K Isaaz, J P Simon, M Boursier, K Khalifé, J Y Thisse, E Aliot
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 27 Issue 7 Pg. 1662-8 (Jun 1996) ISSN: 0735-1097 [Print] United States
• PMID: 8636551 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Streptokinase
• Plasminogen Activators
• Tissue Plasminogen Activator

Topics

• Aged
• Female
• Humans
• Male
• Middle Aged
• Myocardial Infarction (drug therapy)
• Plasminogen Activators (therapeutic use)
• Recurrence
• Risk Factors
• Smoking (adverse effects)
• Streptokinase (therapeutic use)
• Stroke Volume
• Thrombolytic Therapy
• Tissue Plasminogen Activator (therapeutic use)
• Treatment Failure
• Vascular Patency