ArticleSpringerPlus2016
The bizzare phenomenon of smokers' paradox in the immediate outcome post acute myocardial infarction: an insight into the Malaysian National Cardiovascular Database-Acute Coronary Syndrome (NCVD-ACS) registry year 2006-2013.
Article in SpringerPlus, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers.
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Who cites it
22 citing papers in PubMed, 40 citations in OpenAlex.
- Smoking status and the efficacy of remote ischaemic conditioning: a secondary analysis of the RICAMIS trial.Stroke and vascular neurology · 2026Trial
- Emerging Prognostic Risk Factors in Acute Coronary Syndromes: Beyond Traditional Risk Assessment.Journal of clinical medicine · 2026Review
- Smoking cessation after first STEMI enhances infarct healing: a cardiac MRI study.European heart journal. Cardiovascular Imaging · 2026Article
- Effects of Smoking on Neurocognitive Outcomes in Patients with Carbon Monoxide Poisoning.Journal of clinical medicine · 2025Article
- Impact of smoking on procedural outcomes and all-cause mortality following acute myocardial infarction: A misleading early-stage pseudoparadox with ultimately reduced survival.International journal of cardiology. Cardiovascular risk and prevention · 2024Article
- Association Between Cardiovascular Health and Subclinical Atherosclerosis Among Young Adults Using the American Heart Association's "Life's Essential 8" Metrics.Journal of the American Heart Association · 2024Article
- In-Hospital Mortality in Patients With Acute Myocardial Infarction: A Literature Overview.Cureus · 2024Review
- Machine-learning based risk prediction of in-hospital outcomes following STEMI: the STEMI-ML score.Frontiers in cardiovascular medicine · 2024Article
- Effect of Limb Salvage by Excimer Laser Angioplasty Plus Low-Pressure Balloon Inflation in Chronic Limb-Threatening Ischemia Patients with Infrapopliteal Vessel Disease.Acta Cardiologica Sinica · 2023Article
- Social Determinants of Health and Mortality After Premature and Non-premature Acute Coronary Syndrome.Mayo Clinic proceedings. Innovations, quality & outcomes · 2023Article
- Unfolding the reality of the smoking paradox in a South Asian cohort of patients presenting with ST-elevation acute coronary syndrome undergoing primary percutaneous coronary intervention.SAGE open medicine · 2023Article
- Carboxyhemoglobin (CO-Hb) Correlates with Hemolysis and Hospital Mortality in Extracorporeal Membrane Oxygenation: A Retrospective Registry.Diagnostics (Basel, Switzerland) · 2022Article
- Association between baseline smoking status and clinical outcomes following myocardial infarction.Frontiers in cardiovascular medicine · 2022Article
- Effects of Smoking on Very-Long Term Mortality after First ST Elevation Myocardial Infarction.Arquivos brasileiros de cardiologia · 2022Article
- Smoking and Neuropsychiatric Disease-Associations and Underlying Mechanisms.International journal of molecular sciences · 2021Review
- Association between smoking status and outcomes in myocardial infarction patients undergoing percutaneous coronary intervention.Scientific reports · 2021Article
- Smoking Status and Functional Outcomes in Young Stroke.Frontiers in neurology · 2021Article
- Baseline factors identified for the prediction of good responders in patients with end-stage diffuse coronary artery disease undergoing intracoronary CD34+ cell therapy.Stem cell research & therapy · 2020Article
- The impact of smoking on mortality after acute ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: a retrospective cohort outcome study at 3 years.Journal of thrombosis and thrombolysis · 2019Article
- Association between endothelial function and early neurological improvement in atrial fibrillation-related ischemic stroke.Frontiers in neurologyArticle
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
background'Smoker's paradox' is a controversial phenomenon of an unexpected favourable outcome of smokers post acute myocardial infarction. There are conflicting evidences from the literature so far. We investigate for the existence of this phenomenon in our post acute myocardial infarction patients.
methodsWe analysed 12,442 active smokers and 10,666 never-smokers diagnosed with STEMI and NSTEMI from the Malaysian National Cardiovascular Database-Acute Coronary Syndrome (NCVD-ACS) year 2006-2013 from 18 hospitals across Malaysia. Comparisons in the baseline characteristics, clinical presentation, in-hospital treatment and short term clinical outcome were made between the two groups. To compare the clinical outcome, an extensive multivariate adjustment was made to estimate the allcause mortality risk ratios for both groups.
resultsThe active smokers were younger (smokers 53.7 years vs non-smokers 62.3 years P < 0.001) and had lower cardiovascular risk burden and other co-morbidities. STEMI is more common in smokers and intravenous thrombolysis was the main reperfusion therapy in both groups. Smokers had a higher rate of in-hsopital coronary revascularisation in NSTEMI group (21.6 % smokers vs 16.7 % non-smokers P < 0.001) but similar to non-smokers in the STEMI group. Multivariate adjusted mortality risk ratios showed significantly lower mortality risks of smokers at both in-hospital (RR 0.510 [95 % CI 0.442-0.613]) and 30-day post discharge (RR 0.534 [95 % CI 0.437-0.621]).
conclusionSmoking seems to be associated with a favourable outcome post myocardial infarction. The phenomenon of 'smoker's paradox' is in fact a reality in our patients population. The definitive explanation for this unexpected protective effect of smoking remains unclear.
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Registered trials
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