The impact of smoking status on platelet reactivity and its association on clinical outcomes in east asian AMI patients with stent implantation

Abstract

Abstract Background Smoking is one of the major risk factors as well as prognostic factors for cardiovascular disease including AMI. Purpose We sought to investigate the impact of smoking on major adverse cardiac and cerebrovascular events (MACCE) in AMI patient with stent implantation and also, we tried to confirm the issue’s of Smoker's paradox. Methods The multicenter PTRG-DES (Platelet function and geno Type-Related long-term proGnosis in DES-treated patients) consortium is a multicenter, real-world registry of patients who underwent PCI with DES and received DAPT of aspirin and clopidogrel in South Korea. We assessed PRUs as continuous and categorical measures. Additionally, the cutoff of HPR to ADP was defined as ≥ 252 PRU according to the time-dependent receiver-operating characteristic (ROC) curve analysis for East Asian patients. In this present analysis, smoking patients was defined according to data recorded at the time of admission. The primary outcome was the occurrence of major adverse cardiac and cerebrovascular events (MACCE) were evaluated at 5-year follow-up. Results The 3,285 patients (28.0%) were smoker, and 4,001 patients (34.2%) were HPR patients. Smoker significantly increased the risk of death (HR=1.302 [95% CI: 1.019-1.664]), but did not increase the risk of MACCE. In smoking patients, HPR phenotype was significant association with MACCE (HR=1.532 [95% CI: 1.139-2.061]), death (HR=1.995 [95% CI: 1.335-2.983]), stent thrombosis (HR=3.986 [95% CI: 1.559-10.193]), in non-smoker patients, HPR was significantly associated with stent thrombosis (HR=3.018 [95% CI:1.591-5.726]). Conclusion Smoking was significantly associated with 5-year risks of all-cause death and MACCE. Smoking exaggerate HPR effect on MACCE. However, the smoker’s paradox was not observed in our study.