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    Temporal trends in all-cause mortality according to smoking status: Insights from the Global Registry of Acute Coronary Events

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    Authors
    Arbel, Yaron
    FitzGerald, Gordon
    Yan, Andrew T.
    Tan, Mary K.
    Fox, Keith A. A.
    Gore, Joel M.
    Steg, Phillippe Gabriel
    Eagle, Kim A.
    Brieger, David
    Montalescot, Gilles
    Budaj, Andrzej
    Lopez-Sendon, Jose
    Avezum, Alvaro
    Granger, Christopher B.
    Goodman, Shaun G.
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    UMass Chan Affiliations
    Department of Medicine, Division of Cardiovascular Medicine
    Center for Outcomes Research
    Document Type
    Journal Article
    Publication Date
    2016-09-01
    Keywords
    Cardiology
    Cardiovascular Diseases
    Health Services Research
    
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    Link to Full Text
    http://dx.doi.org/10.1016/j.ijcard.2016.05.064
    Abstract
    Objective Smoking has been shown to be a risk factor for heart disease. However, it was recently reported that despite the evolution in therapy for acute coronary syndrome (ACS), smokers have not demonstrated improved outcomes. The aim of the present study was to evaluate the temporal trends in the treatments and outcomes across a broad spectrum of ACS patients (STEMI and non-ST-elevation ACS [NSTEACS]) according to smoking status on presentation in the Global Registry of Acute Coronary Events (GRACE). Methods Our cohort was stratified into 3 groups: current smokers, former smokers and never smokers. We evaluated trends in demographics, treatment modalities and outcomes in these 3 groups from 1999 to 2007. Results The study population comprised a total of 63,015 patients admitted to hospital with an ACS and with identifiable baseline smoking status. Smokers presented with STEMI more often than non-smokers. There was an unadjusted decline in 30-day mortality in all 3 groups. However, the adjusted decline was not statistically significant among current smokers (HR = 0.98 per study year, 95% CI 0.94–1.01, p = 0.20). A subgroup analysis of 22,894 STEMI patients demonstrated no reduction in annual adjusted 30-day mortality rates among smokers (HR = 1.01, 95% CI 0.96–1.06 (Table 5), whereas former and never smokers' mortality declined. Conclusions Over the years 1999–2007, 30-day mortality declined in patients presenting with acute coronary syndrome. However, smokers presenting with STEMI did not demonstrate a reduction in mortality.
    Source
    Arbel Y, FitzGerald G, Yan AT, Tan MK, Fox KA, Gore JM, Steg PG, Eagle KA, Brieger D, Montalescot G, Budaj A, Lopez-Sendon J, Avezum A, Granger CB, Goodman SG. Temporal trends in all-cause mortality according to smoking status: Insights from the Global Registry of Acute Coronary Events. Int J Cardiol. 2016 Sep 1;218:291-7. doi: 10.1016/j.ijcard.2016.05.064. Epub 2016 May 15. PubMed PMID: 27240154. Link to article on publisher's site
    DOI
    10.1016/j.ijcard.2016.05.064
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/27194
    PubMed ID
    27240154
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.ijcard.2016.05.064
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