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Usaid K. Allahwala John C. Murphy Gregory I.C. Nelson Ravinay Bhindi 《Cardiovascular Revascularization Medicine》2013,14(4):213-217
PurposeThe ‘smoker's paradox’ refers to the observation of favorable prognosis in current smokers following an acute myocardial infarction (AMI). Initial positive findings were in the era of fibrinolysis, with more contemporary studies finding conflicting results. We sought to determine the presence of a ‘smoker's paradox’ in a cohort of ST Elevation Myocardial Infarction (STEMI) patients identified via field triage, treated with primary percutaneous coronary intervention (pPCI).MethodsThis was a single center retrospective cohort study identifying consecutive STEMI patients presenting for pPCI via field triage. The primary end points were all cause mortality, major adverse cardiac events (MACE), major bleeding, in-hospital cardiac arrest and length of stay (LOS).ResultsA total of 382 patients were included in the study. Current smokers were more likely to be younger (p < 0.00001), male (p < 0.001) and have fewer comorbidities, including renal impairment (p < 0.01) and a history of AMI (p < 0.05). Current smokers also had a shorter ischemic time (p < 0.05), were less likely to have collateral circulation (p < 0.05), and more likely to have signs of pulmonary edema at presentation (p < 0.05). There was no difference between smoking groups and all cause mortality (p = 0.67), MACE (p = 0.49), major bleeding (p = 0.49) or in-hospital cardiac arrest (p = 0.43). Current smokers had a shorter LOS (p < 0.05). In multivariate analysis smoking status did not correlate with primary outcomes.ConclusionThe ‘smoker's paradox’ does not appear to be relevant among STEMI patients undergoing pPCI, identified via field triage. The previously documented ‘smoker's paradox’ may have been an indication of patient characteristics and the historical treatment of STEMI with thrombolysis. Further studies with larger numbers may be warranted. 相似文献
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Allahwala Usaid K. Nour Daniel Alsanjari Osama Bhatia Kunwardeep Nagaraja Vinayak Khatri Jaikirshan J. Cockburn James Hildick-Smith David Sakata Yasuhiko Ward Michael Weaver James C. Bhindi Ravinay 《Journal of thrombosis and thrombolysis》2021,51(4):1005-1016
Journal of Thrombosis and Thrombolysis - Acute coronary collateralisation of an infarct-related arterial (IRA) territory may be identified during angiography for ST elevation myocardial infarction... 相似文献
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Tom Hsun-Wei Huang Kalpa De Silva Usaid K. Allahwala Edward J. Danson Pasi K. Karjalainen Olli A. Kajander Ravinay Bhindi 《Cardiovascular Revascularization Medicine》2019,20(1):16-21
Objective
This study aimed to assess the pathophysiological differences between saphenous vein grafts (SVG) and native coronary arteries (NCA) following presentation with non-ST elevated myocardial infarction (NSTEMI).Background
There is accelerated pathogenesis of de novo coronary disease in harvested SVG following coronary artery bypass (CABG) surgery, which contributes to both early and late graft failure, and is also causal in adverse outcomes following vein graft PCI. However in vivo assessment, with OCT imaging, comparing the differences between vein grafts and NCAs has not previously been performed.Methods
We performed a retrospective, observational, analysis in patients who underwent PCI with adjunctive OCT imaging following presentation with NSTEMI, where the infarct-related artery (IRA) was either in an SVG or NCA.Results
A total of 1550 OCT segments was analysed from thirty patients with a mean age of 66.3 (±9.0) years were included. The mean graft age of 13.9 (±5.6) years in the SVG group. OCT imaging showed that the SVG group had evidence of increased lipid pool burden (lipid pool quadrants, 2.1 vs 2.7; p?=?0.021), with a reduced fibro-atheroma cap-thickness in the SVG group (45.0?μm vs 38.5?μm; p?=?0.05) and increased burden of calcification (calcified lesion length?=?0.4?mm vs 1.8?mm; p?=?0.007; calcified quadrants?=?0.2 vs 0.9; p?=?0.001; arc of superficial calcium deposits?=?11.6° vs 50.9°; p?=?0.007) when compared to NCA.Conclusion
This OCT study has demonstrated that vein grafts have a uniquely atherogenic environment which leads to the development of calcified, lipogenic, thin-capped fibro-atheroma's, which may be pivotal in the increased, acute and chronic graft failure rate, and may underpin the increased adverse outcomes following vein graft PCI. 相似文献8.
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