Risk Profile and In-hospital Outcomes in Smokers vs Nonsmokers Men and Women with Acute Myocardial Infarction in Durres Population

Smoking is a risk factor that increases acute myocardial infarction (AMI) occurrence. Its impact on the clinical outcomes is still controversial. The aim of this study is to evaluate the prevalence of risk factors in smokers and its impact on in-hospital outcomes in men and women with acute myocardial infarction. We have included in the study 499 pts with AMI admitted in cardiology October 2011 to October 2014. The baseline characteristics, traditional risk factors for CHD and inhospital outcome were recorded. Statistical analyses were performed with SPSS 16.0. P value of <0.05 was considered statistically significant. Out of 499 pts, 55.1% of patients were smokers and 44.9% were nonsmokers. Smokers were younger than nonsmokers, had more obesity and family history but they had less the history of HT and DM compared to nonsmokers. Mortality was higher in nonsmokers group. The women were older than men. Male smokers were 5 years younger compared to nonsmokers. Women smokers were younger than nonsmokers but no the significant difference. The proportion of smokers among men was significantly greater compared to women. In both genders, anterior MI localization and ≥2 Killip class was lower in smokers group. No significant difference was observed in lipid parameters, left ventricular ejection fraction and in hospital stay in smokers compared to nonsmokers. One-vessel disease was more frequently observed in smokers, whereas multivessel disease was more common in nonsmokers. Pulmonary edema, cardiogenic shock was lower in smokers but AV block and VF were higher in this group. In-hospital mortality was lower in and smoking status was an independent predictor of mortality. As a conclusion, smoking decreased the age of first AMI and was an independent predictor of mortality. Smokers were younger, had less hypertension and diabetes, had more single vessel disease, less anterior IM, Killip class and had lower mortality rate. 1. Background Acute myocardial infarction (AMI) is one of the main reasons of morbidity, mortality and the functional disability worldwide in both men and women. The prevalence of ischemic heart disease (IHD) is greater in men than in women, although men and women present with the same risk factors except the female experience of menopause and oral contraceptive use by them. It was believed that there was an important gender-related variability in the prevalence of risk factors for IHD [1]. It is estimated that smoking is able to cause almost 10% of cardiovascular disease (CVD) [2]. INTERHEART study, identified cigarette smoking as the second and independent risk factor for coronary heart disease (CHD) and AMI and this was consistent with regards to ethnicity, gender and geographical region [3,4]. It demonstrated also that smoking of 1-5 cigarettes daily increases the risk of an AMI 40% and showed a clear dose-response relationship with CHD [5]. There are nearly one billion smokers around the world. The prevalence of daily tobacco smoking varied widely among the six WHO regions in 2009 and is higher in the WHO European Region compared to the WHO African Region (31% vs 10%) [6]. According Yusuf et al, all forms of tobacco including filtered, unfiltered cigarettes, pipes and cigars are harmful [3]. About six million people die from tobacco use and exposure to second hand smoke each year, accounting for 6% of all female and 12% of all male deaths in the world [7,8] . By 2030, tobacco-related deaths are projected to increase to more than 8 million deaths every year [9,8]. The mechanism for the adverse effect of tobacco use on the coronary arterial circulation is complex and multifactorial. A large number of studies have demonstrated clear data of the dangerous effects of cigarette smoking on public health [10]. Cigarette smoking is estimated to cause nearly 50% of all the deaths in the industrialized area [11]. However, convincing data in the literature show that current Imperial Journal of Interdisciplinary Research (IJIR) Vol-2, Issue-2 , 2016 ISSN : 2454-1362 , http://www.onlinejournal. in Imperial Journal of Interdisciplinary Research (IJIR) Page 562 smokers present lower unadjusted mortality rates following acute myocardial infarction [12-15]. It is thought that this is attributed to the younger age, lower co-morbidity, more aggressive treatment and lower risk profile of the smoker. Some other studies, have used multivariate analyses to demonstrate a good survival for smokers. That is called, the “smoker’s paradox”[16]. The aim of our study was the prevalence of risk factors in smokers and its impact on in-hospital outcomes in men and women with acute myocardial infarction in Durres population. 2. Material and Methods We, prospectively, enrolled in the study 499 consecutive patients with AMI hospitalized in the Cardiology Department, Regional Hospital, Durres, Albania from October 2011 to 2014. In both smokers and nonsmokers patients were analyzed risk factors (cigarette smoking, age, gender, obesity, hypertension and level of blood lipids, diabetes, family history), localization of AMI and in-hospital outcome. The smokers were considered the patients that reported to have smoked cigarettes or other tobacco products in previous years and those who quit smoking during the last year. The diagnosis of AMI was made according to the World Health Organization criteria and the patients with AMI must met at least two of these three criteria: typical chest pain for myocardial ischemia lasting at least 30 min, ST elevation of > 2 mm in two or more contiguous precordial leads and enzymatic evidence of myocardial necrosis. In-Hospital outcomes were measured in terms of complications, disturbance of rhythm, hospital stay and inhospital death. The study protocol was approved by hospital ethical committee. Statistical analyses were performed with SPSS 16.0 software . Continuous variables were expressed as mean ± standard deviation. The student test was used to compare continuous variables and categorical variables were compared using a χ2 test. To determine the influence of various factors on mortality an uni-variate analysis was performed, including age, gender, history of HT and DM, smoking, the number of vessels involved and Killip class (II, on admission). The odds ratio (OR) and 95% confidence intervals (CI) were also calculated. A P value of <0.05 was considered statistically significant.