Abstract
Background: Smoking has been linked to coronary artery vasoconstriction and increased myocardial oxygen demand. However, its impact on the outcomes of type 2 myocardial infarction (T2MI) remains unknown. Methods: We analyzed odds and predictors of in-hospital mortality in smokers vs. non-smokers from National Inpatient Sample (2018) T2MI hospitalizations after excluding secondary diagnoses of Type 1 MI. Results: Of 33155 T2MI admissions, 55.4% (n=14780) were smokers and 44.6% non-smokers (n=18375). Smokers were often younger (median 68 vs 74 yrs) and males (57.7% vs. 44.9%) than non-smokers. Unadjusted (OR 0.67, 95CI 0.50-0.91 (p=0.01) and demographically adjusted (OR 0.71, 95CI 0.52-0.98 (p=0.034) regression analyses revealed “smokers’ paradox” for in-hospital mortality. However, when additionally adjusted for comorbidities, the lower risk of all-cause mortality in smokers vs non-smokers failed to reach a statistical significance (OR 0.81, 95CI 0.56-1.16, p=0.253) [Table 1a] . Smokers had a higher rate of substance abuse, depression, and prior MI/PCI/CABG/stroke (p<0.05). Higher risk of all-cause mortality was found in patients with advanced age (OR 1.05), males (vs female OR 1.92) whereas whites (vs blacks OR 0.61, Hispanics OR 0.70), patients from higher-income quartile (76-100th vs. 0-25th OR 0.37) had a lower risk of mortality. CHF (OR 27.20), sepsis (OR 8.83), fluid-electrolyte disorders (OR 4.72), metastatic cancers (OR 3.29), coagulopathy (OR 2.16), prior VTE (OR 2.66) and CKD (OR 1.41) raised the odds of mortality in smokers whereas hypertension, hyperlipidemia, past cancer, prior PCI and prior TIA/Stroke showed lower odds of mortality (all p<0.05) [Table 1b] . Conclusion: In-hospital mortality associated with T2MI in unadjusted and sociodemographically adjusted models showed "Smoker's Paradox" but when controlled for comorbidities the lower odds failed to reach a statistical significance. The predictors of T2MI related mortality in smokers may help clinicians to identify high-risk patients.
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