Impact of smoking on no-reflow phenomenon after percutaneous coronary intervention in patients with acute ST elevation myocardial infarction

Abstract

Background: No-reflow phenomenon after percutaneous coronary intervention (PCI) in patients with acute ST-segment-elevation myocardial infarction (STEMI) is relatively common and has therapeutic and prognostic implications. On the other hand cigarette smoking is known to be deleterious in patients with coronary artery disease, but the effect of smoking on no-reflow phenomenon is less investigated. The aim of our study was to assess the impact of smoking on no-reflow phenomenon after PCI in STEMI patients.Materials and Methods: A total number of 141 patients who were admitted to Chamran Hospital (Isfahan, Iran) between March and September, 2012 with diagnosis of STEMI, enrolled into our Cohort study. Patients were divided into current smoker and non-smoker groups (based on patient’s information). All patients underwent primary PCI or rescue PCI Within the first 12 hours of chest pain. No-reflow phenomenon, thrombolysis in myocardial infarction (TIMI) flow and 24-hour complications were assessed in both groups. Results: 47 current smoker cases (32.9%) and 94 (65.7%) nonsmoker cases were evaluated. Smokers in comparison to non-smokers were younger (53.47 ± 10.59 versus 61.46 ± 10.55, P-value <0.001) and they were less likely to be hypertensive (15.2% versus 44.7%, P-value< 0.001),   diabetic (17% versus 36.2%, P-value <0.05), and female gender (4.3% versus 25.5%, P-value <0.01). Angiographic and procedural characteristics of both groups were similar. 9 patients died during the first 24 hours after PCI (4.3% of smokers and 6.4% of non-smokers, P-value: 0.72). No-reflow phenomenon was observed in 29.8% of current smokers and 31.5% of non-smokers (P-value = 0.77). Smoking status and no-reflow phenomenon were not significantly correlated even after adjustments for age, gender, history of diabetes, hypertension, history of CAD and the extent of stenosis (OR = 1.68; 95% CI 0.68-4.10, P-value = 0.25 ).Conclusion: According to the present study, no-reflow phenomenon or short-term complications were not significantly lower in smokers. So better results in previous studies may be explained by differences in baseline characteristics and not by smoking status itself. Current smokers developed STEMI about 8 years earlier than non-smokers with similar age and sex-adjusted risk of no-reflow phenomenon and 24 hour mortality. These results emphasize role of efforts to encourage smoking cessation as prevention of myocardial infarction.

Keywords: Primary Percutaneous Coronary Intervention, Cigarette Smoking, Thrombolysis in Myocardial Infarction (TIMI flow), No-Reflow Phenomenon.