Association between smoking and in-hospital mortality in patients with acute myocardial infarction: results from a prospective, multicentre, observational study in China
Introduction Smoking is a well-established risk factor for cardiovascular disease. However, the effect of smoking on in-hospital mortality in patients with acute myocardial infarction (AMI) who are managed by contemporary treatment is still unclear.Methods A cohort study was conducted using data fro...
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BMJ Publishing Group
2019-08-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/8/e030252.full |
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| author | Hao Wang Chenxi Song Rui Fu Kefei Dou Jingang Yang Haiyan Xu Xiaojin Gao Shuai Liu Xiaoxue Fan Yuejin Yang |
| author_facet | Hao Wang Chenxi Song Rui Fu Kefei Dou Jingang Yang Haiyan Xu Xiaojin Gao Shuai Liu Xiaoxue Fan Yuejin Yang |
| author_sort | Hao Wang |
| collection | DOAJ |
| description | Introduction Smoking is a well-established risk factor for cardiovascular disease. However, the effect of smoking on in-hospital mortality in patients with acute myocardial infarction (AMI) who are managed by contemporary treatment is still unclear.Methods A cohort study was conducted using data from the China AMI registry between 2013 and 2016. Eligible patients were diagnosed with AMI in accordance with the third universal definition of MI. Propensity score (PS) matching and multivariable logistic regression were used to control for confounders. Subgroup analysis was performed to examine whether the association between smoking and in-hospital mortality varies according to baseline characteristics.Results A total of 37 614 patients were included. Smokers were younger and more frequently men with fewer comorbidities than non-smokers. After PS matching and multivariable log regression analysis were performed, the difference in in-hospital mortality between current smokers versus non-smokers was reduced, but it was still significant (5.1% vs 6.1%, p=0.0045; adjusted OR 0.78, 95% CI 0.69 to 0.88, p<0.001). Among all subgroups, there was a trend towards lower in-hospital mortality in current or ex-smokers compared with non-smokers.Conclusions Smoking is associated with lower in-hospital mortality in patients with AMI, even after multiple analyses to control for potential confounders. This ‘smoker’s paradox’ cannot be fully explained by confounding alone.Trial registration number NCT01874691. |
| format | Article |
| id | doaj-art-2a8db9e96fb44802801ca0e892f1fb1f |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-08-01 |
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| spelling | doaj-art-2a8db9e96fb44802801ca0e892f1fb1f2025-08-20T01:53:26ZengBMJ Publishing GroupBMJ Open2044-60552019-08-019810.1136/bmjopen-2019-030252Association between smoking and in-hospital mortality in patients with acute myocardial infarction: results from a prospective, multicentre, observational study in ChinaHao Wang0Chenxi Song1Rui Fu2Kefei Dou3Jingang Yang4Haiyan Xu5Xiaojin Gao6Shuai Liu7Xiaoxue Fan8Yuejin Yang9Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, China1 Coronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Peking Union Medical College, Beijing, ChinaDepartment of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Cardiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, National Clinical Research Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College/ National Center for Cardiovascular Diseases, Beijing, ChinaDepartment of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaCoronary Heart Disease Center, Fuwai Hospital, Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases and Peking Union Medical College, Beijing, ChinaCoronary Heart Disease Center, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaDepartment of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaIntroduction Smoking is a well-established risk factor for cardiovascular disease. However, the effect of smoking on in-hospital mortality in patients with acute myocardial infarction (AMI) who are managed by contemporary treatment is still unclear.Methods A cohort study was conducted using data from the China AMI registry between 2013 and 2016. Eligible patients were diagnosed with AMI in accordance with the third universal definition of MI. Propensity score (PS) matching and multivariable logistic regression were used to control for confounders. Subgroup analysis was performed to examine whether the association between smoking and in-hospital mortality varies according to baseline characteristics.Results A total of 37 614 patients were included. Smokers were younger and more frequently men with fewer comorbidities than non-smokers. After PS matching and multivariable log regression analysis were performed, the difference in in-hospital mortality between current smokers versus non-smokers was reduced, but it was still significant (5.1% vs 6.1%, p=0.0045; adjusted OR 0.78, 95% CI 0.69 to 0.88, p<0.001). Among all subgroups, there was a trend towards lower in-hospital mortality in current or ex-smokers compared with non-smokers.Conclusions Smoking is associated with lower in-hospital mortality in patients with AMI, even after multiple analyses to control for potential confounders. This ‘smoker’s paradox’ cannot be fully explained by confounding alone.Trial registration number NCT01874691.https://bmjopen.bmj.com/content/9/8/e030252.full |
| spellingShingle | Hao Wang Chenxi Song Rui Fu Kefei Dou Jingang Yang Haiyan Xu Xiaojin Gao Shuai Liu Xiaoxue Fan Yuejin Yang Association between smoking and in-hospital mortality in patients with acute myocardial infarction: results from a prospective, multicentre, observational study in China BMJ Open |
| title | Association between smoking and in-hospital mortality in patients with acute myocardial infarction: results from a prospective, multicentre, observational study in China |
| title_full | Association between smoking and in-hospital mortality in patients with acute myocardial infarction: results from a prospective, multicentre, observational study in China |
| title_fullStr | Association between smoking and in-hospital mortality in patients with acute myocardial infarction: results from a prospective, multicentre, observational study in China |
| title_full_unstemmed | Association between smoking and in-hospital mortality in patients with acute myocardial infarction: results from a prospective, multicentre, observational study in China |
| title_short | Association between smoking and in-hospital mortality in patients with acute myocardial infarction: results from a prospective, multicentre, observational study in China |
| title_sort | association between smoking and in hospital mortality in patients with acute myocardial infarction results from a prospective multicentre observational study in china |
| url | https://bmjopen.bmj.com/content/9/8/e030252.full |
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