Smoking paradox in coronary function and structure of acute ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention
Abstract Background The Smoking paradox has generated inconsistent findings concerning the clinical prognosis of acute ST-segment elevation myocardial infarction (STEMI) patients, while providing limited insights into coronary anatomy and function which are crucial prognostic factors. Therefore, thi...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-08-01
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| Series: | BMC Cardiovascular Disorders |
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| Online Access: | https://doi.org/10.1186/s12872-024-04093-6 |
| _version_ | 1827145953944010752 |
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| author | Shanghong Zhang Ziqiang Lin Bingyan Yu Jieliang Liu Junguo Jin Guang Li Haojian Dong |
| author_facet | Shanghong Zhang Ziqiang Lin Bingyan Yu Jieliang Liu Junguo Jin Guang Li Haojian Dong |
| author_sort | Shanghong Zhang |
| collection | DOAJ |
| description | Abstract Background The Smoking paradox has generated inconsistent findings concerning the clinical prognosis of acute ST-segment elevation myocardial infarction (STEMI) patients, while providing limited insights into coronary anatomy and function which are crucial prognostic factors. Therefore, this study aimed to further investigate the existence of smoking paradox in coronary anatomy and function. Methods This study divided STEMI patients into smokers and non-smokers. Quantitative coronary angiography, angiography‑derived microcirculatory resistance (AMR) and quantitative flow ratio (QFR) were utilized to analyze coronary anatomy and function. These parameters were compared using multivariable analysis and propensity score matching. The clinical outcomes were evaluated using Kaplan-Meier curve and Cox regression. Results The study included 1258 patients, with 730 in non-smoker group and 528 in smoker group. Smokers were significantly younger, predominantly male, and had fewer comorbidities. Without adjusting for confounders, smokers exhibited larger lumen diameter [2.03(1.45–2.57) vs. 1.90(1.37–2.49), P = 0.033] and lower AMR [244(212–288) vs. 260(218–301), P = 0.006]. After matching and multivariate adjustment, smokers exhibited inversely smaller lumen diameter [1.97(1.38–2.50) vs. 2.15(1.63–2.60), P = 0.002] and higher incidence of coronary microvascular dysfunction [233(53.9%) vs. 190(43.6%), P = 0.002], but showed similar AMR and clinical outcomes compared to non-smokers. There was no difference in QFR between two groups. Conclusion Smoking among STEMI patients undergoing pPCI was associated with smaller lumen diameter and higher occurrence of coronary microvascular dysfunction, although it had no further impact on clinical prognosis. The smoking paradox observed in coronary anatomy or function may be explained by younger age, gender, and lower prevalence of comorbidities. |
| first_indexed | 2025-03-20T20:22:48Z |
| format | Article |
| id | doaj.art-c4b51a9795674ea8925f5e9043ff37f7 |
| institution | Directory Open Access Journal |
| issn | 1471-2261 |
| language | English |
| last_indexed | 2025-03-20T20:22:48Z |
| publishDate | 2024-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cardiovascular Disorders |
| spelling | doaj.art-c4b51a9795674ea8925f5e9043ff37f72024-08-18T11:05:45ZengBMCBMC Cardiovascular Disorders1471-22612024-08-0124111010.1186/s12872-024-04093-6Smoking paradox in coronary function and structure of acute ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary interventionShanghong Zhang0Ziqiang Lin1Bingyan Yu2Jieliang Liu3Junguo Jin4Guang Li5Haojian Dong6Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical UniversityGuangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical UniversityGuangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical UniversityGuangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical UniversityGuangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical UniversityGuangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical UniversityGuangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical UniversityAbstract Background The Smoking paradox has generated inconsistent findings concerning the clinical prognosis of acute ST-segment elevation myocardial infarction (STEMI) patients, while providing limited insights into coronary anatomy and function which are crucial prognostic factors. Therefore, this study aimed to further investigate the existence of smoking paradox in coronary anatomy and function. Methods This study divided STEMI patients into smokers and non-smokers. Quantitative coronary angiography, angiography‑derived microcirculatory resistance (AMR) and quantitative flow ratio (QFR) were utilized to analyze coronary anatomy and function. These parameters were compared using multivariable analysis and propensity score matching. The clinical outcomes were evaluated using Kaplan-Meier curve and Cox regression. Results The study included 1258 patients, with 730 in non-smoker group and 528 in smoker group. Smokers were significantly younger, predominantly male, and had fewer comorbidities. Without adjusting for confounders, smokers exhibited larger lumen diameter [2.03(1.45–2.57) vs. 1.90(1.37–2.49), P = 0.033] and lower AMR [244(212–288) vs. 260(218–301), P = 0.006]. After matching and multivariate adjustment, smokers exhibited inversely smaller lumen diameter [1.97(1.38–2.50) vs. 2.15(1.63–2.60), P = 0.002] and higher incidence of coronary microvascular dysfunction [233(53.9%) vs. 190(43.6%), P = 0.002], but showed similar AMR and clinical outcomes compared to non-smokers. There was no difference in QFR between two groups. Conclusion Smoking among STEMI patients undergoing pPCI was associated with smaller lumen diameter and higher occurrence of coronary microvascular dysfunction, although it had no further impact on clinical prognosis. The smoking paradox observed in coronary anatomy or function may be explained by younger age, gender, and lower prevalence of comorbidities.https://doi.org/10.1186/s12872-024-04093-6Acute ST-segment elevation myocardial infarctionSmokingQuantitative coronary angiographyAngiography‑derived microcirculatory resistanceQuantitative flow ratio |
| spellingShingle | Shanghong Zhang Ziqiang Lin Bingyan Yu Jieliang Liu Junguo Jin Guang Li Haojian Dong Smoking paradox in coronary function and structure of acute ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention BMC Cardiovascular Disorders Acute ST-segment elevation myocardial infarction Smoking Quantitative coronary angiography Angiography‑derived microcirculatory resistance Quantitative flow ratio |
| title | Smoking paradox in coronary function and structure of acute ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention |
| title_full | Smoking paradox in coronary function and structure of acute ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention |
| title_fullStr | Smoking paradox in coronary function and structure of acute ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention |
| title_full_unstemmed | Smoking paradox in coronary function and structure of acute ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention |
| title_short | Smoking paradox in coronary function and structure of acute ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention |
| title_sort | smoking paradox in coronary function and structure of acute st segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention |
| topic | Acute ST-segment elevation myocardial infarction Smoking Quantitative coronary angiography Angiography‑derived microcirculatory resistance Quantitative flow ratio |
| url | https://doi.org/10.1186/s12872-024-04093-6 |
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