Temporal trends in all-cause mortality of smokers versus non-smokers hospitalized with ST-segment elevation myocardial infarction

Yaron Arbel*, Shlomi Matetzky, Natalie Gavrielov-Yusim, Meital Shlezinger, Gad Keren, Arie Roth, Eran Kopel, Ariel Finkelstein, Shmuel Banai, Robert Klempfner, Ilan Goldenberg

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Background/objectives Over the past decade, the development of novel management strategies has resulted in improved outcomes among patients hospitalized with ST-segment myocardial infarction (STEMI). The aim of the present study was to compare temporal trends in the mortality of smokers versus non-smokers admitted with STEMI in a real world setting between 2000 and 2010. Methods We evaluated time-dependent changes in the clinical characteristics, management strategies, and one year 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). The primary endpoint of the study was the occurrence of one-year all-cause mortality. Results A total of 4564 STEMI patients were enrolled in the 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 = 0.664 CI 95% 0.52-0.85, p = 0.0009), whereas smokers who were enrolled in more recent survey periods did not display a significant risk reduction (HR = 1.08 CI 95% 0.77-1.51, p = 0.67). 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.

Original languageEnglish
Pages (from-to)171-176
Number of pages6
JournalInternational Journal of Cardiology
Issue number1
StatePublished - Sep 2014


  • Mortality
  • Primary PCI
  • Smoker's paradox
  • Smoking
  • Trends


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