Skip to main content
SpringerLink
Log in

Impact of smoking on cardiac magnetic resonance infarct characteristics and clinical outcome in patients with non-ST-elevation myocardial infarction

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Data derived from several studies suggest a better survival in smokers with acute myocardial infarction, a phenomenon referred to as the ‘smoker’s paradox’. We aimed to investigate the association of smoking with cardiac magnetic resonance (CMR) imaging determined infarct severity and major adverse cardiac events (MACE) defined as the occurrence of death, reinfarction, and congestive heart failure at 12 months in patients with non-ST-elevation myocardial infarction (NSTEMI) reperfused by early percutaneous coronary intervention (PCI). In this multicenter, registry study 311 NSTEMI patients underwent CMR imaging 3 (interquartile range [IQR] 2–4) days after PCI. Myocardial salvage index (MSI), infarct size (IS), and microvascular obstruction (MVO) as well as MACE rate were compared according to admission smoking status. Approximately one-third of patients were current smokers (n = 122, 39%). Smokers were significantly younger and less likely to have hypertension as compared to non-smokers (all p < 0.05). The extent of MSI (63.2, IQR 28.9–85.4 vs. 65.6, IQR 42.2–82.9, p = 0.30), and IS (7.2, IQR 2.3–15.7%LV vs. 7.0, IQR 2.2–12.4%LV, p = 0.27) did not differ significantly between smokers and non-smokers. Despite similar prevalence of MVO, MVO (%LV) was higher in smokers compared to non-smokers (2.0, IQR 0.9–4.7%LV vs. 1.2, IQR 0.7–2.2%LV, p = 0.03). MACE rates at 12 months were comparable in smokers and non-smokers (5.7% vs. 7.4%, p = 0.65). In NSTEMI patients, smoking is neither associated with increased myocardial salvage nor less severe myocardial damage. Clinical outcome at 12 months was similar in smokers and non-smokers.

Trial registration NCT03516578.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Camici PG, Crea F (2007) Coronary microvascular dysfunction. N Engl J Med 356(8):830–840

    Article  CAS  PubMed  Google Scholar 

  2. Barua RS, Ambrose JA (2013) Mechanisms of coronary thrombosis in cigarette smoke exposure. Arterioscler Thromb Vasc Biol 33(7):1460–1467

    Article  CAS  PubMed  Google Scholar 

  3. Molstad P (1991) First myocardial infarction in smokers. Eur Heart J 12(7):753–759

    Article  CAS  PubMed  Google Scholar 

  4. Barbash GI, White HD, Modan M, Diaz R, Hampton JR, Heikkila J et al (1993) Significance of smoking in patients receiving thrombolytic therapy for acute myocardial infarction. Experience gleaned from the International Tissue Plasminogen Activator/Streptokinase Mortality Trial. Circulation 87(1):53–58

    Article  CAS  PubMed  Google Scholar 

  5. Grines CL, Topol EJ, O’Neill WW, George BS, Kereiakes D, Phillips HR et al (1995) Effect of cigarette smoking on outcome after thrombolytic therapy for myocardial infarction. Circulation 91(2):298–303

    Article  CAS  PubMed  Google Scholar 

  6. Barbash GI, Reiner J, White HD, Wilcox RG, Armstrong PW, Sadowski Z et al (1995) Evaluation of paradoxic beneficial effects of smoking in patients receiving thrombolytic therapy for acute myocardial infarction: mechanism of the “smoker’s paradox” from the GUSTO-I trial, with angiographic insights. Global Utilization of Streptokinase and Tissue-Plasminogen Activator for Occluded Coronary Arteries. J Am Coll Cardiol 26(5):1222–1229

    Article  CAS  PubMed  Google Scholar 

  7. Ruiz-Bailen M, de Hoyos EA, Reina-Toral A, Torres-Ruiz JM, Alvarez-Bueno M, Gomez Jimenez FJ et al (2004) Paradoxical effect of smoking in the Spanish population with acute myocardial infarction or unstable angina: results of the ARIAM Register. Chest 125(3):831–840

    Article  PubMed  Google Scholar 

  8. Albertal M, Cura F, Escudero AG, Thierer J, Trivi M, Padilla LT et al (2008) Mechanism involved in the paradoxical effects of active smoking following primary angioplasty: a subanalysis of the protection of distal embolization in high-risk patients with acute myocardial infarction trial. J Cardiovasc Med 9(8):810–812

    Article  Google Scholar 

  9. Verouden NJ, Haeck JD, Kuijt WJ, Meuwissen M, Koch KT, Henriques JP et al (2010) Clinical and angiographic predictors of ST-segment recovery after primary percutaneous coronary intervention. Am J Cardiol 105(12):1692–1697

    Article  PubMed  Google Scholar 

  10. Kim RJ, Fieno DS, Parrish TB, Harris K, Chen EL, Simonetti O et al (1999) Relationship of MRI delayed contrast enhancement to irreversible injury, infarct age, and contractile function. Circulation 100(19):1992–2002

    Article  CAS  PubMed  Google Scholar 

  11. Wu KC, Zerhouni EA, Judd RM, Lugo-Olivieri CH, Barouch LA, Schulman SP et al (1998) Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction. Circulation 97(8):765–772

    Article  CAS  PubMed  Google Scholar 

  12. Wagner A, Mahrholdt H, Holly TA, Elliott MD, Regenfus M, Parker M et al (2003) Contrast-enhanced MRI and routine single photon emission computed tomography (SPECT) perfusion imaging for detection of subendocardial myocardial infarcts: an imaging study. Lancet 361(9355):374–379

    Article  PubMed  Google Scholar 

  13. de Waha S, Desch S, Eitel I, Fuernau G, Zachrau J, Leuschner A et al (2010) Impact of early vs. late microvascular obstruction assessed by magnetic resonance imaging on long-term outcome after ST-elevation myocardial infarction: a comparison with traditional prognostic markers. Eur Heart J 31(21):2660–2668

    Article  PubMed  Google Scholar 

  14. Bellenger NG, Davies LC, Francis JM, Coats AJ, Pennell DJ (2000) Reduction in sample size for studies of remodeling in heart failure by the use of cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2(4):271–278

    Article  CAS  PubMed  Google Scholar 

  15. Eitel I, Kubusch K, Strohm O, Desch S, Mikami Y, de Waha S et al (2011) Prognostic value and determinants of a hypointense infarct core in T2-weighted cardiac magnetic resonance in acute reperfused ST-elevation-myocardial infarction. Circ Cardiovasc Imaging 4(4):354–362

    Article  PubMed  Google Scholar 

  16. Eitel I, de Waha S, Wohrle J, Fuernau G, Lurz P, Pauschinger M et al (2014) Comprehensive prognosis assessment by CMR imaging after ST-segment elevation myocardial infarction. J Am Coll Cardiol 64(12):1217–1226

    Article  PubMed  Google Scholar 

  17. Desch S, Engelhardt H, Meissner J, Eitel I, Sareban M, Fuernau G et al (2012) Reliability of myocardial salvage assessment by cardiac magnetic resonance imaging in acute reperfused myocardial infarction. Int J Cardiovasc Imaging 28(2):263–272

    Article  PubMed  Google Scholar 

  18. Eitel I, Desch S, Fuernau G, Hildebrand L, Gutberlet M, Schuler G et al (2010) Prognostic significance and determinants of myocardial salvage assessed by cardiovascular magnetic resonance in acute reperfused myocardial infarction. J Am Coll Cardiol 55(22):2470–2479

    Article  PubMed  Google Scholar 

  19. Reinstadler SJ, Eitel C, Fuernau G, de Waha S, Desch S, Mende M et al (2017) Association of smoking with myocardial injury and clinical outcome in patients undergoing mechanical reperfusion for ST-elevation myocardial infarction. Eur Heart J Cardiovasc Imaging 18(1):39–45

    Article  PubMed  Google Scholar 

  20. Gennaro G, Brener SJ, Redfors B, Kirtane AJ, Genereux P, Maehara A et al (2016) Effect of smoking on infarct size and major adverse cardiac events in patients with large anterior ST-elevation myocardial infarction (from the INFUSE-AMI trial). Am J Cardiol 118(8):1097–1104

    Article  PubMed  Google Scholar 

  21. de Waha S, Eitel I, Desch S, Scheller B, Bohm M, Lauer B et al (2013) Thrombus Aspiration in ThrOmbus containing culpRiT lesions in Non-ST-Elevation Myocardial Infarction (TATORT-NSTEMI): study protocol for a randomized controlled trial. Trials 14:110

    Article  PubMed  PubMed Central  Google Scholar 

  22. Stiermaier T, Eitel I, de Waha S, Poss J, Fuernau G, Thiele H et al (2017) Myocardial salvage after primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction presenting early versus late after symptom onset. Int J Cardiovasc Imaging 33(10):1571–1579

    Article  PubMed  Google Scholar 

  23. Klug G, Mayr A, Schenk S, Esterhammer R, Schocke M, Nocker M et al (2012) Prognostic value at 5 years of microvascular obstruction after acute myocardial infarction assessed by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 14:46

    Article  PubMed  PubMed Central  Google Scholar 

  24. Mayr A, Pedarnig K, Klug G, Schocke M, Pachinger O, Jaschke W et al (2012) Regional functional recovery after acute myocardial infarction: a cardiac magnetic resonance long-term study. Int J Cardiovasc Imaging 28(6):1445–1453

    Article  PubMed  Google Scholar 

  25. Mayr A, Klug G, Feistritzer HJ, Reinstadler SJ, Reindl M, Esterhammer R et al (2017) Myocardial edema in acute myocarditis: relationship of T2 relaxometry and late enhancement burden by using dual-contrast turbo spin-echo MRI. Int J Cardiovasc Imaging 33(11):1789–1794

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Feistritzer HJ, Klug G, Reinstadler SJ, Grober MT, Mair J, Kirchmair R et al (2015) Fetuin-A is related to infarct size, left ventricular function and remodelling after acute STEMI. Open Heart 2(1):e000244

    Article  PubMed  PubMed Central  Google Scholar 

  27. Thiele H, Kappl MJ, Conradi S, Niebauer J, Hambrecht R, Schuler G (2006) Reproducibility of chronic and acute infarct size measurement by delayed enhancement-magnetic resonance imaging. J Am Coll Cardiol 47(8):1641–1645

    Article  PubMed  Google Scholar 

  28. Reinstadler SJ, Stiermaier T, Reindl M, Feistritzer HJ, Fuernau G, Eitel C et al (2019) Intramyocardial haemorrhage and prognosis after ST-elevation myocardial infarction. Eur Heart J Cardiovasc Imaging 20(2):138–146

    Article  PubMed  Google Scholar 

  29. Symons R, Masci PG, Francone M, Claus P, Barison A, Carbone I et al (2016) Impact of active smoking on myocardial infarction severity in reperfused ST-segment elevation myocardial infarction patients: the smoker’s paradox revisited. Eur Heart J 37(36):2756–2764

    Article  PubMed  Google Scholar 

  30. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H et al (2018) 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 39(2):119–177

    Article  Google Scholar 

  31. Gottlieb S, Boyko V, Zahger D, Balkin J, Hod H, Pelled B et al (1996) Smoking and prognosis after acute myocardial infarction in the thrombolytic era (Israeli Thrombolytic National Survey). J Am Coll Cardiol 28(6):1506–1513

    Article  CAS  PubMed  Google Scholar 

  32. Andrikopoulos GK, Richter DJ, Dilaveris PE, Pipilis A, Zaharoulis A, Gialafos JE et al (2001) In-hospital mortality of habitual cigarette smokers after acute myocardial infarction; the “smoker’s paradox” in a countrywide study. Eur Heart J 22(9):776–784

    Article  CAS  PubMed  Google Scholar 

  33. Weisz G, Cox DA, Garcia E, Tcheng JE, Griffin JJ, Guagliumi G et al (2005) Impact of smoking status on outcomes of primary coronary intervention for acute myocardial infarction–the smoker’s paradox revisited. Am Heart J 150(2):358–364

    Article  PubMed  Google Scholar 

  34. Allahwala UK, Murphy JC, Nelson GI, Bhindi R (2013) Absence of a ‘smoker’s paradox’ in field triaged ST-elevation myocardial infarction patients undergoing percutaneous coronary intervention. Cardiovasc Revasc Med 14(4):213–217

    Article  PubMed  Google Scholar 

  35. Park HW, Yoon CH, Kang SH, Choi DJ, Kim HS, Cho MC et al (2013) Early- and late-term clinical outcome and their predictors in patients with ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction. Int J Cardiol 169(4):254–261

    Article  PubMed  Google Scholar 

  36. Wakabayashi K, Romaguera R, Laynez-Carnicero A, Maluenda G, Ben-Dor I, Sardi G et al (2011) Impact of smoking on acute phase outcomes of myocardial infarction. Coron Artery Dis 22(4):217–222

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany

    Hans-Josef Feistritzer, Alexander Jobs, Mohamed Abdel-Wahab, Philipp Lurz, Steffen Desch & Holger Thiele

  2. Leipzig Heart Institute, Leipzig, Germany

    Hans-Josef Feistritzer, Alexander Jobs, Mohamed Abdel-Wahab, Philipp Lurz, Steffen Desch & Holger Thiele

  3. Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany

    Ingo Eitel, Suzanne de Waha-Thiele & Thomas Stiermaier

  4. German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany

    Ingo Eitel, Alexander Jobs, Suzanne de Waha-Thiele, Thomas Stiermaier & Steffen Desch

  5. University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria

    Sebastian J. Reinstadler, Martin Reindl, Gert Klug & Bernhard Metzler

Authors
  1. Hans-Josef Feistritzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ingo Eitel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alexander Jobs
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Suzanne de Waha-Thiele
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas Stiermaier
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mohamed Abdel-Wahab
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Philipp Lurz
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sebastian J. Reinstadler
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Martin Reindl
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Gert Klug
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Bernhard Metzler
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Steffen Desch
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Holger Thiele
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hans-Josef Feistritzer.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Feistritzer, HJ., Eitel, I., Jobs, A. et al. Impact of smoking on cardiac magnetic resonance infarct characteristics and clinical outcome in patients with non-ST-elevation myocardial infarction. Int J Cardiovasc Imaging 35, 1079–1087 (2019). https://doi.org/10.1007/s10554-019-01556-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-019-01556-2

Keywords

Search

Navigation