Objectives: The aim of the present study was to compare temporal trends in the outcomes of smokers versus non-smokers admitted with STEMI in a real world setting between 2000 and 2010.
Background: Over the past decade, the development of novel management strategies has resulted in improved outcomes among patients hospitalized with ST-segment myocardial infarction (STEMI).
Methods: We evaluated time-dependent changes in the clinical characteristics, management strategies, and all-cause mortality of STEMI patients who were enrolled in the biannual Acute Coronary Syndrome Israeli Survey (ACSIS) between 2000 and 2010, categorized as smokers (n=2399) and non-smokers (n=3069). We divided the survey periods into early (2000-2004) and late (2006-2010).
Results: A total of 5468 STEMI patients were enrolled in study. Compared with non-smokers, smokers were significantly younger and displayed a significantly lower rate of all-cause mortality at 30 days and 1-year. Both smokers and non-smokers who were enrolled in the late survey period received more evidence-based therapies (primary PCI and guideline-based medications) (p<0.001 for all). There was a significant reduction in the risk of 1-year all-cause mortality only among non-smokers (HR=0.74 CI 95% 0.60-0.89, p=0.002), whereas smokers who were enrolled in more recent survey periods did not display a significant risk reduction (HR=1.01 CI 95% 0.72-1.4, p=0.95).
Conclusion: Survival following STEMI among smokers has not improved over the past decade despite corresponding changes in management strategies. Future trials should focus on reducing the risk in smokers.
