Author + information
- Received November 8, 1994
- Revision received May 26, 1995
- Accepted May 31, 1995
- Published online November 1, 1995.
- Gabriel I. Barbash, MD, MPHa,*,
- Jonathan Reiner, MDa,*,
- Harvey D. White, MBa,†,
- Robert G. Wilcox, MDa,‡,
- Paul W. Armstrong, MD§,
- Zygmunt Sadowsi, MDa,f,
- Douglas Morris, MDa,¶,
- Philip Aylward, MDa,#,
- Lynn H. Woodlief, MSa,**,
- Eric J. Topol, MD, FACCa,††,
- Robert M. Califf, MD, FACCa,**,
- Allan M. Ross, MD, FACCa,*,
- The GUSTO-I Investigatorsa
- ↵*Address for correspondence:Dr. Gabriel I. Barbash, Tel-Aviv Sourasky Medical Center, Ichilov Hospital, 6 Weizman Street, Tel-Aviv 64239, Israel.
Objectives. Our purpose was to evaluate the relation between smoking and the outcomes of patients receiving thrombolysis for acute myocardial infarction.
Background. A paradoxic beneficial effect has been observed in smokers with a myocardial infarction. We analyzed outcomes and baseline characteristics of 11,975 nonsmokers, 11,117 ex-smokers and 17,507 current smokers in a multinational trial of thrombolysis for acute myocardial infarction.
Methods. Patients were randomized to one of four thrombolytic protocols. An angiographic substudy in 2,431 patients evaluated reperfusion, reocclusion and ventricular function. Effects of smoking were evaluated by logistic regression analysis after adjustment for age and gender. A mortality model evaluated the simultaneous effect of baseline characteristics on the prognostic importance of smoking. These processes were performed with data from both the main trial and the angiographic substudy; then angiographic factors (coronary anatomy, patency and ejection fraction) were added to the model.
Results. Smokers were significantly younger by a mean of 11 years) and had less comorbidity or severe coronary artery disease than nonsmokers. Nonsmokers had significantly higher hospital and 30-day mortality rates (9.9% and 10.3%, respectively) than smokers (3.7% vs. 4%, respectively, both p < 0.001) and more in-hospital complications. The unadjusted odds ratio for 30-day mortality in nonsmokers was 3.36 (95% confidence interval [CI]2.08 to 5.41), 1.21 (95% CI 0.71 to 2.08) after adjustment for age and gender and 1.08 (95% CI 0.59 to 1.96) after adjustment for all clinical baseline characteristics.
Conclusions. Smokers receiving thrombolysis for acute myocardial infarction presented 11 years earlier than nonsmokers, which generally accounted for their better outcome. When other differences in clinical and angiographic baseline factors and therapeutic responses were evaluated, no significant difference in mortality was seen between smokers and nonsmokers.
This study was supported by grants from Bayer, New York, New York; CIBA-Corning, Medfield, Massachusetts; Genentech, South San Francisco, California; ICI Pharmaceuticals. Wilmington, Delaware; and Sanofi Pharmaceuticals. Paris. France. It was presented in part at the 67th annual scientific sessions of the American Heart Association, Dallas, Texas, November 1994.
- Received November 8, 1994.
- Revision received May 26, 1995.
- Accepted May 31, 1995.
- American College of Cardiology