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      Smoking status and life expectancy after acute myocardial infarction in the elderly

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      Heart
      BMJ

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          Abstract

          <div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d2145742e143">Objective</h5> <p id="P1">Smokers have lower short-term mortality after acute myocardial infarction than non-smokers; however, little is known about the long-term effects of smoking on life expectancy after AMI. The study aimed to quantify the burden of smoking after AMI using life expectancy and years of life lost. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d2145742e148">Methods</h5> <p id="P2">We analyzed data from the Cooperative Cardiovascular Project, a medical record study of 158,349 elderly Medicare patients with AMI and over 17 years of follow-up, to evaluate the age-specific association of smoking with life expectancy and years of life lost after AMI. </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d2145742e153">Results</h5> <p id="P3">Our sample included 23,447 (14.8%) current smokers. Current smokers had lower crude mortality up to 5 years, which was largely explained by their younger age at AMI. After adjustment other patient characteristics, smoking was associated with lower 30-day (HR 0.91, 95% confidence interval (CI) 0.87–0.94) but higher long-term mortality (17-year HR 1.19, 95% CI 1.17–1.20) after AMI. Overall, crude life expectancy estimates were lower for current smokers than non-smokers at all ages, which translated into sizeable numbers of life-years lost attributable to smoking. As age at AMI increased, the magnitude of life-years lost due to smoking decreased. After full risk adjustment, the differences in life expectancy between current smokers and non-smokers persisted at all ages. </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d2145742e158">Conclusions</h5> <p id="P4">Current smoking is associated with lower life expectancy and large numbers of life-years lost after AMI. Our findings lend additional support to smoking cessation efforts after AMI. </p> </div>

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          Most cited references26

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          Years of Potential Life Lost (YPLL)—What Does it Measure?

          The concept of years of potential life lost (YPLL) involves estimating the average time a person would have lived had he or she not died prematurely. This measure is used to help quantify social and economic loss owing to premature death, and it has been promoted to emphasize specific causes of death affecting younger age groups. YPLL inherently incorporates age at death, and its calculation mathematically weights the total deaths by applying values to death at each age. The method of calculating YPLL varies from author to author, each producing different rankings of leading causes of premature death. One can choose between heart disease, cancer, or accidents as the leading cause of premature death, depending on which method is used. Confusion in the use of this measure stems from a misunderstanding of the value system inherent in the calculation, as well as from differing views as to values that should be applied to each age at death.
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            Impact of smoking status on outcomes of primary coronary intervention for acute myocardial infarction--the smoker's paradox revisited.

            We sought to determine the relationship between cigarette smoking and outcomes after mechanical reperfusion therapy in acute myocardial infarction (AMI). Prior studies have found that smokers with AMI have lower mortality rates and a more favorable response to fibrinolytic therapy than nonsmokers. The impact of cigarette smoking in patients undergoing primary percutaneous coronary intervention has not been examined. In the CADILLAC trial, 2082 patients with AMI were randomized to percutaneous transluminal coronary angioplasty +/- abciximab versus stenting +/- abciximab. Data on smoking status were prospectively collected and follow-up continued for 1 year. At the time of presentation, 638 (31%) patients had never smoked, 546 (26%) were former smokers, and 898 (45%) were currently smoking. In comparison to nonsmokers, current smokers were younger, more often men, and less frequently had diabetes, hypertension, prior AMI, and triple-vessel coronary disease. Procedural success rates were unrelated to smoking status. Mortality was lowest in current smokers, intermediate in former smokers, and highest in nonsmokers at 30 days (1.3% vs 1.7% vs 3.5%, respectively, P = .02) and 1 year (2.9% vs 3.7% vs 6.6%, P = .0008). After multivariate correction for differences in baseline variables, however, current smoking status was no longer protective from late mortality (hazard ratio 0.96, 95% CI 0.52-1.76, P = .89). The "smoker's paradox" extends to patients undergoing primary PCI for AMI, with increased survival seen in current smokers, an effect entirely explained by differences in baseline risk and not smoking status per se. The deleterious effects of smoking are expressed in the occurrence of AMI nearly a decade earlier than in nonsmokers, with similar age-adjusted risk, mandating intensive primary and secondary cigarette-cessation efforts.
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              Effect of Smoking Cessation on Mortality After Myocardial Infarction

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                Author and article information

                Journal
                Heart
                Heart
                BMJ
                1355-6037
                1468-201X
                January 04 2016
                January 15 2016
                January 15 2016
                November 23 2015
                : 102
                : 2
                : 133-139
                Article
                10.1136/heartjnl-2015-308263
                5459390
                26596792
                e3fe8188-4e43-43c6-8c9b-3dbd4ce6b5c7
                © 2015
                History

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