Document Detail

Impact of Smoking on Outcomes of Patients With ST-Segment Elevation Myocardial Infarction (from the HORIZONS-AMI Trial).
MedLine Citation:
PMID:  21864816     Owner:  NLM     Status:  Publisher    
We assessed the impact of smoking on outcomes in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention using alternative antithrombotic regimens and stent types. In the HORIZONS-AMI trial 3,602 patients were randomly assigned to unfractionated heparin (UFH) plus a glycoprotein IIb/IIIa inhibitor (GPI) or bivalirudin alone and paclitaxel-eluting stents or bare-metal stents. Compared to nonsmokers, smokers had significantly lower rates of mortality and major bleeding at 30 days and at 1 year; however, the differences were no longer significant after covariate adjustment. Smoking was associated with increased rates of definite/probable stent thrombosis (ST) at 1 year (adjusted RR 1.99, 95% confidence interval 1.28 to 3.10) mainly because of a higher rate of late ST after paclitaxel-eluting stent implantation (1.9% vs 0.4%, p = 0.0006). In smokers bivalirudin monotherapy compared to UFH plus a GPI was associated with lower mortality at 30 days (0.5% vs 2.2%, p = 0.002) and at 1 year (1.8% vs 4.0%, p = 0.008). No decrease in mortality was seen with bivalirudin in nonsmokers. Major bleeding was significantly decreased with bivalirudin regardless of smoking status (smokers 3.7% vs 8.9%, p <0.0001; nonsmokers 6.5% vs 9.6%, p = 0.01). In conclusion, in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention, smoking is an independent predictor of definite/probable ST at 1 year. Bivalirudin monotherapy compared to UFH plus a GPI decreased major bleeding regardless of smoking status but may have different effects on individual components of ischemic events.
Kenji Goto; Eugenia Nikolsky; Alexandra J Lansky; George Dangas; Bernhard Witzenbichler; Helen Parise; Giulio Guagliumi; Ran Kornowski; Bimmer E Claessen; Martin Fahy; Roxana Mehran; Gregg W Stone
Related Documents :
15766816 - Long-term cost-effectiveness of clopidogrel given for up to one year in patients with a...
15298036 - Considerations in combination therapy: fibrinolytics plus glycoprotein iib/iiia recepto...
10502236 - Safety of glycoprotein iib-iiia inhibitors: a heart surgeon's perspective.
16168276 - Aspirin use in chronic heart failure: what should we recommend to the practitioner?
18557136 - Intravenous magnesium for cardiac arrhythmias: jack of all trades.
9855096 - Sterile vegetations in children with severe tetralogy of fallot.
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-8-23
Journal Detail:
Title:  The American journal of cardiology     Volume:  -     ISSN:  1879-1913     ISO Abbreviation:  -     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-8-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Meta-Analysis of Monotherapy Versus Combination Therapy for Pulmonary Arterial Hypertension.
Next Document:  Outcome of Sirolimus-Eluting Versus Zotarolimus-Eluting Coronary Stent Implantation in Patients With...