Current Smoking and Prognosis After Acute ST-Segment Elevation Myocardial Infarction: New Pathophysiological Insights

Caroline Haig, David Carrick, Jaclyn Carberry, Kenneth Mangion, Annette Maznyczka, Kirsty Wetherall, Margaret McEntegart, Mark C. Petrie, Hany Eteiba, Mitchell Lindsay, Stuart Hood, Stuart Watkins, Andrew Davie, Ahmed Mahrous, Ify Mordi, Nadeem Ahmed, Vannesa Teng Yue May, Ian Ford, Aleksandra Radjenovic, Paul WelshNaveed Sattar, Keith G. Oldroyd, Colin Berry

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Abstract

Objectives: The aim of this study was to mechanistically investigate associations among cigarette smoking, microvascular pathology, and longer term health outcomes in patients with acute ST-segment elevation myocardial infarction (MI). Background: The pathophysiology of myocardial reperfusion injury and prognosis in smokers with acute ST-segment elevation MI is incompletely understood. Methods: Patients were prospectively enrolled during emergency percutaneous coronary intervention. Microvascular function in the culprit artery was measured invasively. Contrast-enhanced magnetic resonance imaging (1.5-T)was performed 2 days and 6 months post-MI. Infarct size and microvascular obstruction were assessed using late gadolinium enhancement imaging. Myocardial hemorrhage was assessed with T2* mapping. Pre-specified endpoints included: 1)all-cause death or first heart failure hospitalization; and 2)cardiac death, nonfatal MI, or urgent coronary revascularization (major adverse cardiovascular events). Binary logistic regression (odds ratio [OR]with 95% confidence interval [CI])with smoking status was used. Results: In total, 324 patients with ST-segment elevation MI were enrolled (mean age 59 years, 73% men, 60% current smokers). Current smokers were younger (age 55 ± 11 years vs. 65 ± 10 years, p < 0.001), with fewer patients with hypertension (52 ± 27% vs. 53 ± 41%, p = 0.007). Smokers had better TIMI (Thrombolysis In Myocardial Infarction)flow grade (≥2 vs. ≤1, p = 0.024)and ST-segment resolution (none vs. partial vs. complete, p = 0.010)post–percutaneous coronary intervention. On day 1, smokers had higher circulating C-reactive protein, neutrophil, and monocyte levels. Two days post-MI, smoking independently predicted infarct zone hemorrhage (OR: 2.76; 95% CI: 1.42 to 5.37; p = 0.003). After a median follow-up period of 4 years, smoking independently predicted all-cause death or heart failure events (OR: 2.20; 95% CI: 1.07 to 4.54)and major adverse cardiovascular events (OR: 2.79; 95% CI: 2.30 to 5.99). Conclusions: Smoking is associated with enhanced inflammation acutely, infarct-zone hemorrhage subsequently, and longer term adverse cardiac outcomes. Inflammation and irreversible myocardial hemorrhage post-MI represent mechanistic drivers for adverse long-term prognosis in smokers. (Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction. [BHF MR-MI]; NCT02072850)

Original languageEnglish
Pages (from-to)993-1003
Number of pages11
JournalJACC: Cardiovascular Imaging
Volume12
Issue number6
Early online date18 Jul 2018
DOIs
Publication statusPublished - Jun 2019

Keywords

  • cigarette smoking
  • magnetic resonance imaging
  • microcirculation
  • myocardial hemorrhage
  • myocardial infarction
  • prognosis

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    Haig, C., Carrick, D., Carberry, J., Mangion, K., Maznyczka, A., Wetherall, K., McEntegart, M., Petrie, M. C., Eteiba, H., Lindsay, M., Hood, S., Watkins, S., Davie, A., Mahrous, A., Mordi, I., Ahmed, N., Teng Yue May, V., Ford, I., Radjenovic, A., ... Berry, C. (2019). Current Smoking and Prognosis After Acute ST-Segment Elevation Myocardial Infarction: New Pathophysiological Insights. JACC: Cardiovascular Imaging, 12(6), 993-1003. https://doi.org/10.1016/j.jcmg.2018.05.022