Vol.:(0123456789) 1 3 Journal of Thrombosis and Thrombolysis https://doi.org/10.1007/s11239-019-01812-1 The impact of smoking on mortality after acute ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: a retrospective cohort outcome study at 3 years Lloyd Steele 1  · James Palmer 1  · Amelia Lloyd 1  · James Fotheringham 2  · Javaid Iqbal 1,3  · Ever D. Grech 3 © Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract The “smoker’s paradox”, where smokers have improved survival post-myocardial infarction, was predominantly observed in the thrombolytic era. However, evidence for the smoker’s paradox in the current era of PCI therapy is both limited and inconsistent. We aimed to examine the efect of smoking status on survival in unselected ST-elevation myocardial infarction (STEMI) patients managed by primary percutaneous coronary intervention (PCI). Data were collected for all patients with acute STEMI undergoing primary PCI at The South Yorkshire Cardiothoracic Centre, UK over a 5-year period between 2009 and 2014. Diferences in survival by smoking status were assessed before and after adjustment for diferences in baseline variables using a Kaplan–Meier curve and a Cox regression analysis, respectively. A total of 3133 STEMI patients were included in the study. After adjustment for diferences in baseline variables, smoking was associated with a signifcantly increased mortality (hazard ratio 1.35 (95% CI 1.04–1.74)) compared to never smokers after 3 years. The risk for ex-smokers (hazard ratio 0.99 (0.76–1.28)) was similar to never smokers. There were no signifcant diferences in survival by smoking status at 30 days and 1 year. In this large registry of STEMI patients managed by primary PCI, smokers had a signifcantly higher 3-year mortality than non-smokers. This study is the frst to not only dispel the existence of the smoker’s paradox, but to highlight a high-risk subgroup who may warrant tailored secondary prevention treatment, including smoking cessation. Keywords Smoker’s paradox · Smoking cessation · Tobacco use disorder · Acute coronary syndromes · Acute myocardial infarction Abbreviations DANAMI-2 Second Danish Multicenter Trial in Acute Myocardial Infarction NHS REC National Health Service Research Ethics Committee ONS Ofce for National Statistics Highlights • The “smoker’s paradox” was predominantly observed in the thrombolytic era. • Data from PCI studies on the smoker’s paradox is limited and inconsistent. • We did not fnd any evidence of a “smoker’s paradox” in STEMI patients treated by PCI. • Smoking was associated with a signifcantly increased risk of mortality post-STEMI. • We highlight a high-risk subgroup who may warrant tai- lored secondary prevention. Introduction Cigarette smoking, a well-established modifable risk factor for cardiovascular disease [1], is associated with a fvefold increased risk of acute ST-elevation myocardial infarction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11239-019-01812-1) contains supplementary material, which is available to authorized users. * Ever D. Grech Ever.Grech@sth.nhs.uk 1 The University of Shefeld, Shefeld, UK 2 The School of Health and Related Research (ScHARR), University of Shefeld, Shefeld, UK 3 The South Yorkshire Cardiothoracic Centre, Northern General Hospital, Shefeld, UK