Abstract
Objective. To determine whether there is an association between smoking and the location of acute myocardial infarctions. Methods. Using a cohort from our hospital and published cohorts from Ireland, Uruguay, and Israel, we calculated odds of having an inferior wall as opposed to an anterior wall acute myocardial infarction among smokers and nonsmokers. Results. In our cohort, there was a higher proportion of smokers than nonsmokers in patients with inferior acute myocardial infarctions than in patients with anterior infarctions. This difference was also present in each of the other cohorts. Odds ratios for an inferior versus an anterior acute myocardial infarction among smokers ranged from 1.15 to 2.00 (median odds ratio, 1.32). When the cohorts were combined (n = 3, 160), the pooled odds ratio for an inferior as opposed to an anterior acute myocardial infarction among smokers was 1.38 (95% confidence interval, 1.20 to 1.58) (P < .002). Conclusions. Cigarette smoking increases the risk of inferior wall acute myocardial infarction more than the risk of anterior wall infarction. Smoking thus appears to adversely affect the right coronary arterial circulation to a greater extent than the left coronary arterial circulation by a mechanism not yet understood.
Highlights
Cigarette smoking is a major, independent risk factor for coronary heart disease (CHD) and acute myocardial infarction (AMI) [1, 2]
The prevalence of smoking ranged from 41.9% to 84.7% among patients with inferior AMI and from 36.4% to 74.4% among patients with anterior AMI
In each of the cohorts examined, smokers were overrepresented in the inferior AMI groups compared to the anterior AMI groups
Summary
Cigarette smoking is a major, independent risk factor for coronary heart disease (CHD) and acute myocardial infarction (AMI) [1, 2]. The mechanism for the adverse effect of cigarette smoking on the coronary arterial circulation is complex and multifactorial. Smoking increases both heart rate and blood pressure (and the rate-pressure product), thereby augmenting myocardial oxygen demand. The purpose of the present study was to examine whether smoking influences the location of AMI (inferior wall versus anterior wall). To accomplish this purpose, we examined a recent cohort of patients with AMI from our own institution, all of whom had undergone coronary angiography at the time of their AMI [4]. We employed identical methodologies to extract data from these reports and to calculate the odds of having an inferior as opposed to an anterior AMI among smokers and nonsmokers
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