Angiographic Confirmation of Smokers Paradox in Young Patients with Acute Myocardial Infarction

Abstract

Background: Smoking is a strong risk factor for premature atherosclerosis and cardiovascular events. Smokers suffer from acute coronary syndrome (ACS) at an earlier age and have a more favourable short-term prognosis when compared to non smokers. Aim and Objective: This study is done to assess smoking as a major risk factor for ACS in young patients, evaluate the angiographic profile of smokers when compared to non -smokers, to assess the outcome in young patients with ACS. Methods: This is a cross-sectional prospective analytical study conducted in our institute among 250 consecutive patients less than 40years of age with ACS between May 2015-April 2016. It includes 183 smokers and 67 non smokers. Clinical examination, ECG, ECHO and coronary angiogram were done. Angiographic profile reviewed in detail to assess the involved vessel and nature of the involvement. Results: Anterior wall myocardial infarction was common in smokers than non smokers

(60.6% vs 47.7%). Non ST elevation myocardial infarction is common in non smokers (22.4% vs 7.1%, p < 0.0006). Left anterior descending artery involvement is common in smokers (59.6% vs 55.2%, p<0.008). Single vessel disease (39.3% vs 26.9%, p<0.04) and recanalised vessels (43.7 vs 28.4%, p<0.02) were more common in smokers. Double vessel (23.9% vs 9.3%, p<0.002) and triple vessel disease (20.9% vs 7.6%, p<0.001) were more common in non smokers. Discrete lesions are more common in smokers (68.1% vs 53.5%, p< 0.006). Tubular lesions were more common in non smokers (24.4% vs 12.5%, p<0.003).

Co morbidities like DM (40.3% vs 9.8%, p<0.0001), SHT (22.4% vs 9.3% p<0.006) and dyslipidaemia (65.7% vs 7.1%, p< 0.001) were more common in non smokers. Conclusion: Anterior wall MI is most common, with LAD being involved in around 2/3 patients. Single vessel disease was predominant with discrete type of lesions among young patients with MI.