• Burak Acar, Ozcan Ozeke, Sefa Unal, Mustafa Karakurt, Meryem Kara, Ozgur Kirbas, Fatih Sen, Ahmet Korkmaz, Dursun Aras, and Sinan Aydogdu.
• Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, Ankara, Turkey.
• Indian Heart J. 2016 Nov 1; 68 (6): 816-820.

BackgroundThe 'smoker's paradox' refers to the observation of favorable prognosis in current smokers following an acute ST elevation myocardial infarction (STEMI) in the era of fibrinolysis, however, several STEMI studies have demonstrated conflicting results in patients undergoing primary percutaneous coronary intervention (p-PCI).ObjectiveAim of the current study was to evaluate the impact of cigarette smoking on left ventricular function in STEMI patients undergoing p-PCI.MethodsOur population is represented by 74 first-time anterior STEMI patients undergoing p-PCI, 37 of whom were smokers. We assessed left ventricular function by left ventricular ejection fraction (LVEF) on the second day after admission and at 3-month follow-up. Early predictors of adverse left ventricular remodelling after STEMI treated by p-PCI were examined.ResultsBasal demographics and comorbidities were similar between groups. Although the LVEF during the early phase was higher in smokers compared to non-smokers (44.95±7.93% vs. 40.32±7.28%; p=0.011); it worsened in smokers at follow-up (mean decrease in LVEF: -2.70±5.95%), whereas it improved in non-smokers (mean recovery of LVEF: +2.97±8.45%). In univariate analysis, diabetes mellitus, peak troponin I, current smoking, and lower TIMI flow grade after p-PCI, pain-to-door time and door-to-balloon times were predictors of adverse left ventricular remodelling. After multivariate logistic regression analysis, smoking at admission, lower TIMI flow grade after p-PCI, the pain-to-door time and door-to-balloon times remained independent predictors of deterioration in LVEF.ConclusionTrue or persistent 'smoker's paradox' does not appear to be relevant among STEMI patients undergoing p-PCI. The 'smoker's paradox' is in fact a pseudo-paradox. Further studies with larger numbers may be warranted.Copyright © 2016 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

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