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 effect 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. Differences in survival by smoking status were assessed before and after adjustment for differences 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 differences in baseline variables, smoking was associated with a significantly 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 significant differences 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 significantly higher 3-year mortality than non-smokers. This study is the first 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.
Second Danish Multicenter Trial in Acute Myocardial Infarction
National Health Service Research Ethics Committee
Office for National Statistics
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We thank Dr. Dawn Teare for providing statistical advice.
All authors were involved in the preparation of the manuscript, have read the manuscript, agree with the analyses of the data and the conclusions reached in the manuscript, and are accountable for all aspects of the work.
This study received no specific funding, and was carried out as a University of Sheffield degree project.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
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