A dohányzás hatása a szívinfarktus utáni túlélésre-dohányzási paradoxon Magyarországon?

El Meouch Nedim Márton, Ferenci Tamás, A. Jánosi

Research output: Article

Abstract

Introduction: The strong, positive relationship between smoking and myocardial infarction was proven in the 1960s and 1970s. The prognostic signifcance of smoking in the acute phase of the infarction, and later in patients who survive the acute phase is, however, not clear. Numerous international studies focus on the phenomenon called the .,smoker's paradox", which means that smokers have a lower mortality rate after suffering myocardial infarction than non-smokers. Although in many cases smoking does not have a positive effect on survival after controlling for confounders, an international consensus has not been reached regarding this issue. Aim: The aim of this paper was to investigate whether the paradox effect exists in the case of Hungarian patients after controlling for the patients' risk profles. Method: The database used for the research was based on the 2014-2016 data of the Hungarian Myocardial Infarction Registry (n = 20 811) supervised by the Gottsegen György National Institute of Cardiology. The present analysis uses multivariate methodology to adjust for confounding: logistic regression is used for the short-term survival and survival analysis-with Cox proportional hazards model and Accelerated Failure Time models-is used for the long-term survival. Age, sex, performing of PCI, type of infarction (ST-elevation or not), creatinine abnormality, need for prehospital reanimation, cardiogenic shock and the presence of several comorbidities and medical history data were controlled for in the multivariate analysis. Results: Both the short term-30 day-mortality (OR = 1.517, 99% confdence interval: 1.229-1.872) and the long term mortality (HR = 1.395, 99% confdence interval: 1.232-1.579) were worse for smokers than non-smokers after adjusting for the abovementioned factors. Conclusion: The "smoker's paradox" cannot be observed in the case of Hungarian patients, moreover smoking in itself is associated with worse prognosis.

Original languageHungarian
Pages (from-to)557-565
Number of pages9
JournalOrvosi Hetilap
Volume159
Issue number14
DOIs
Publication statusPublished - ápr. 1 2018

Fingerprint

Hungary
Smoking
Myocardial Infarction
Survival
Infarction
Mortality
Multivariate Analysis
Cardiogenic Shock
Survival Analysis
Cardiology
Proportional Hazards Models
Registries
Comorbidity
Creatinine
Consensus
Logistic Models
Databases
Research

Keywords

  • Mortality
  • Myocardial infarction
  • Smoker's paradox
  • Smoking
  • Survival

ASJC Scopus subject areas

  • Medicine(all)

Cite this

A dohányzás hatása a szívinfarktus utáni túlélésre-dohányzási paradoxon Magyarországon? / Márton, El Meouch Nedim; Tamás, Ferenci; Jánosi, A.

In: Orvosi Hetilap, Vol. 159, No. 14, 01.04.2018, p. 557-565.

Research output: Article

Márton, El Meouch Nedim ; Tamás, Ferenci ; Jánosi, A. / A dohányzás hatása a szívinfarktus utáni túlélésre-dohányzási paradoxon Magyarországon?. In: Orvosi Hetilap. 2018 ; Vol. 159, No. 14. pp. 557-565.
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title = "A doh{\'a}nyz{\'a}s hat{\'a}sa a sz{\'i}vinfarktus ut{\'a}ni t{\'u}l{\'e}l{\'e}sre-doh{\'a}nyz{\'a}si paradoxon Magyarorsz{\'a}gon?",
abstract = "Introduction: The strong, positive relationship between smoking and myocardial infarction was proven in the 1960s and 1970s. The prognostic signifcance of smoking in the acute phase of the infarction, and later in patients who survive the acute phase is, however, not clear. Numerous international studies focus on the phenomenon called the .,smoker's paradox{"}, which means that smokers have a lower mortality rate after suffering myocardial infarction than non-smokers. Although in many cases smoking does not have a positive effect on survival after controlling for confounders, an international consensus has not been reached regarding this issue. Aim: The aim of this paper was to investigate whether the paradox effect exists in the case of Hungarian patients after controlling for the patients' risk profles. Method: The database used for the research was based on the 2014-2016 data of the Hungarian Myocardial Infarction Registry (n = 20 811) supervised by the Gottsegen Gy{\"o}rgy National Institute of Cardiology. The present analysis uses multivariate methodology to adjust for confounding: logistic regression is used for the short-term survival and survival analysis-with Cox proportional hazards model and Accelerated Failure Time models-is used for the long-term survival. Age, sex, performing of PCI, type of infarction (ST-elevation or not), creatinine abnormality, need for prehospital reanimation, cardiogenic shock and the presence of several comorbidities and medical history data were controlled for in the multivariate analysis. Results: Both the short term-30 day-mortality (OR = 1.517, 99{\%} confdence interval: 1.229-1.872) and the long term mortality (HR = 1.395, 99{\%} confdence interval: 1.232-1.579) were worse for smokers than non-smokers after adjusting for the abovementioned factors. Conclusion: The {"}smoker's paradox{"} cannot be observed in the case of Hungarian patients, moreover smoking in itself is associated with worse prognosis.",
keywords = "Mortality, Myocardial infarction, Smoker's paradox, Smoking, Survival",
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T1 - A dohányzás hatása a szívinfarktus utáni túlélésre-dohányzási paradoxon Magyarországon?

AU - Márton, El Meouch Nedim

AU - Tamás, Ferenci

AU - Jánosi, A.

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Introduction: The strong, positive relationship between smoking and myocardial infarction was proven in the 1960s and 1970s. The prognostic signifcance of smoking in the acute phase of the infarction, and later in patients who survive the acute phase is, however, not clear. Numerous international studies focus on the phenomenon called the .,smoker's paradox", which means that smokers have a lower mortality rate after suffering myocardial infarction than non-smokers. Although in many cases smoking does not have a positive effect on survival after controlling for confounders, an international consensus has not been reached regarding this issue. Aim: The aim of this paper was to investigate whether the paradox effect exists in the case of Hungarian patients after controlling for the patients' risk profles. Method: The database used for the research was based on the 2014-2016 data of the Hungarian Myocardial Infarction Registry (n = 20 811) supervised by the Gottsegen György National Institute of Cardiology. The present analysis uses multivariate methodology to adjust for confounding: logistic regression is used for the short-term survival and survival analysis-with Cox proportional hazards model and Accelerated Failure Time models-is used for the long-term survival. Age, sex, performing of PCI, type of infarction (ST-elevation or not), creatinine abnormality, need for prehospital reanimation, cardiogenic shock and the presence of several comorbidities and medical history data were controlled for in the multivariate analysis. Results: Both the short term-30 day-mortality (OR = 1.517, 99% confdence interval: 1.229-1.872) and the long term mortality (HR = 1.395, 99% confdence interval: 1.232-1.579) were worse for smokers than non-smokers after adjusting for the abovementioned factors. Conclusion: The "smoker's paradox" cannot be observed in the case of Hungarian patients, moreover smoking in itself is associated with worse prognosis.

AB - Introduction: The strong, positive relationship between smoking and myocardial infarction was proven in the 1960s and 1970s. The prognostic signifcance of smoking in the acute phase of the infarction, and later in patients who survive the acute phase is, however, not clear. Numerous international studies focus on the phenomenon called the .,smoker's paradox", which means that smokers have a lower mortality rate after suffering myocardial infarction than non-smokers. Although in many cases smoking does not have a positive effect on survival after controlling for confounders, an international consensus has not been reached regarding this issue. Aim: The aim of this paper was to investigate whether the paradox effect exists in the case of Hungarian patients after controlling for the patients' risk profles. Method: The database used for the research was based on the 2014-2016 data of the Hungarian Myocardial Infarction Registry (n = 20 811) supervised by the Gottsegen György National Institute of Cardiology. The present analysis uses multivariate methodology to adjust for confounding: logistic regression is used for the short-term survival and survival analysis-with Cox proportional hazards model and Accelerated Failure Time models-is used for the long-term survival. Age, sex, performing of PCI, type of infarction (ST-elevation or not), creatinine abnormality, need for prehospital reanimation, cardiogenic shock and the presence of several comorbidities and medical history data were controlled for in the multivariate analysis. Results: Both the short term-30 day-mortality (OR = 1.517, 99% confdence interval: 1.229-1.872) and the long term mortality (HR = 1.395, 99% confdence interval: 1.232-1.579) were worse for smokers than non-smokers after adjusting for the abovementioned factors. Conclusion: The "smoker's paradox" cannot be observed in the case of Hungarian patients, moreover smoking in itself is associated with worse prognosis.

KW - Mortality

KW - Myocardial infarction

KW - Smoker's paradox

KW - Smoking

KW - Survival

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