Smokers paradox in non-ST elevation acute coronary syndromes: does it exist?

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction In Iraq; about third of males and 4% of females are smokers. There is no data from Middle eastern countries including Iraq on impact of smoking on prognosis in ACS Purpose to assess if there is smokersˈ paradox in patients with NSTE-ACS in terms of lower adverse in-hospital outcomes in smokers Methods Patients with NSTE-ACS were prospectively included. GRACE score was calculated. Patients were categorised into two groups: smokers vs non-smokers Results n.=200, 34.5% were smokers, smokers were younger 53.6 ± 11.2 vs 61.46 ± 11.2, p < 0.001. smokers were males in 89.9% vs 60.3%, p < 0.001 and were hypertensive in 55.1% vs 77.1% p = 0.001. No significant differences between two groups in having DM, IHD, positive family history of IHD nor in troponin positivity. Smokers had higher GFR 91.4 ± 21.9 vs 79.4 ± 22.1, p = 0.001 and higher haemoglobin 13.8 ± 1.9 vs 13.2 ± 2.1, p = 0.04. AF was recorded in 2.9% of smokers vs 11.5%. No statistical difference between groups regarding prescribed drugs including aspirin, P2Y12 inhibitors, B-blockers, ACEI/ARBs, CCB, nitrate, anticoagulant, statin, MRA or diuretic. Smokers were at high GRACE risk class in 21.7% vs 38.2%, p = 0.01, yet, they were catheterized in 76.8% vs 65.6% in non-smokers, p = 0.1. For those who were catheterized, timing to catheterisation did not differ with smoking, p = 0.06. There was no significant difference between the two groups regarding developing in-hospital acute heart failure, ongoing ischaemic chest pain, life-threatening arrhythmias, cardiogenic shock, stroke or death. Conclusion No smokersˈ paradox was observed as there were no differences in developing adverse in-hospital outcomes according to smoking status, yet smokers presented at lower risk class compared with non-smoker counterparts which can be explained by younger age and lower comorbidities in smokers. Preventive programs should be the goal to encourage smoking cessation to reduce cardiovascular diseases and mortality Abstract Figure. Abstract Figure.