TY - JOUR
T1 - How do smokers differ from nonsmokers in their response to thrombolysis? (The TIMI-4 trial)
AU - Zahger, Doron
AU - Cercek, Bojan
AU - Cannon, Christopher P.
AU - Jordan, Matthew
AU - Davis, Vicki
AU - Braunwald, Eugene
AU - Shah, Prediman K.
N1 - Funding Information:
From the Division of Cardiology, Department of Medlane, Cedars-Sinai Me&cal Center and the Unrversltyo f Cahfornla School of Med-~ane, Los Angeles, Cahfornla, the Cardtovascular DIwslon, Department of Medlane, Bngham & Women's Hospital and Harvard Medical School, Boston, Massachusetts,a nd the Research Tnangle Institute, Research Tnangle Park, North Carohna Dr Zahger was supported by the Wdham Ganz Research Fellowshipo f the Save A Heart Foundation and the study was supported m part by a grant from SmlthKhne Beecham, Phdadelph~a, Pennsylvania Manuscnpt received June 29, 1994, revised manuscript received October 20, 1994, and accepted October 22 Address for repnnts Predlman K Shah, MD, Division of Cardiology, #5314, Cedars-Stoat Me&cal Center, 8700 Beverly Blvd, Los Angeles, Cahfornla 90048
PY - 1995/2/1
Y1 - 1995/2/1
N2 - Smokers with acute myocardial infarction appear to have a better outcome after thrombolysis than do nonsmokers. To identify factors that could contribute to this curious finding, we analyzed data from the Thrombolysis in Myocardial Infarction (TIMI-4) trial, in which 382 patients with acute myocardial infarction were randomized to tissue plasminogen activator, anistreplase, or both. Coronary angiography was performed 90 minutes and 18 to 36 hours after randomization, a myocardial perfusion scan was performed at 18 to 36 hours and before discharge, and a radionuclide ventriculogram was obtained before discharge. Angiographic and clinical outcome variables were determined in current smokers, ex-smokers, and nonsmokers, and regression analysis was used to correct for differences in baseline characteristics. The in-hospital mortality of current smokers was lower than that of ex-smokers and nonsmokers: 2.3% versus 5.2% versus 7.0%, respectively (p = 0.04 by paired comparison, current vs nonsmokers). Ninety minutes after randomization, the incidence of TIMI grade 3 flow was significantly higher in smokers than in ex-smokers and nonsmokers (55% vs 43% and 45%, p = 0.02); this difference was no longer observed at the second angiogram, nor did smokers differ from nonsmokers with respect to residual stenosis, thrombus grade, infarct size, ejection fraction, or recurrent ischemia. Because a strong inverse relation exists between TIMI grade 3 flow at 90 minutes and mortality, our findings suggest that the lower mortality of current smokers after thrombolytic therapy may be related to a higher incidence of early, complete reperfusion.
AB - Smokers with acute myocardial infarction appear to have a better outcome after thrombolysis than do nonsmokers. To identify factors that could contribute to this curious finding, we analyzed data from the Thrombolysis in Myocardial Infarction (TIMI-4) trial, in which 382 patients with acute myocardial infarction were randomized to tissue plasminogen activator, anistreplase, or both. Coronary angiography was performed 90 minutes and 18 to 36 hours after randomization, a myocardial perfusion scan was performed at 18 to 36 hours and before discharge, and a radionuclide ventriculogram was obtained before discharge. Angiographic and clinical outcome variables were determined in current smokers, ex-smokers, and nonsmokers, and regression analysis was used to correct for differences in baseline characteristics. The in-hospital mortality of current smokers was lower than that of ex-smokers and nonsmokers: 2.3% versus 5.2% versus 7.0%, respectively (p = 0.04 by paired comparison, current vs nonsmokers). Ninety minutes after randomization, the incidence of TIMI grade 3 flow was significantly higher in smokers than in ex-smokers and nonsmokers (55% vs 43% and 45%, p = 0.02); this difference was no longer observed at the second angiogram, nor did smokers differ from nonsmokers with respect to residual stenosis, thrombus grade, infarct size, ejection fraction, or recurrent ischemia. Because a strong inverse relation exists between TIMI grade 3 flow at 90 minutes and mortality, our findings suggest that the lower mortality of current smokers after thrombolytic therapy may be related to a higher incidence of early, complete reperfusion.
UR - http://www.scopus.com/inward/record.url?scp=0028936267&partnerID=8YFLogxK
U2 - 10.1016/0002-9149(95)80026-O
DO - 10.1016/0002-9149(95)80026-O
M3 - Article
AN - SCOPUS:0028936267
SN - 0002-9149
VL - 75
SP - 232
EP - 236
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 4
ER -