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Duke University Shanghai Jiaotong University

Impact of Smoking on 30-day and Long-term Mortality in Older Patients : Results From 38,628 NSTEMI Patients .

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Duke University Shanghai Jiaotong University

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  1. Impact of Smoking on 30-day and Long-term Mortality in Older Patients:Results From 38,628 NSTEMI Patients Lan Shen, MD, MS, Shuang Li, MS, Laine Thomas, Ph.D, Tracy Y. Wang, MD, MHS, MSc, Karen P. Alexander, MD, Ying Xian, MD, Ph.D, Eric D. Peterson, MD, MPH, Matthew T. Roe, MD, MHS, Bimal R. Shah, MD, MBA Duke University Shanghai Jiaotong University

  2. Background • Smoking constitutes >30% of preventable cardiovascular death • Despite widespread public health campaigns to curb smoking, smoking still continues to be increasing globally1 • Interestingly, smokers paradoxically showed better short term outcomes after MI in prior studies • However, it is unknown if this paradox exists among older patients (>65 years) within 30-days and longer term mortality 1.http://www.who.int/mediacentre/factsheets/fs339/en/index.html

  3. Methods – Study Population We analyzed 38,628 patients from 445 U.S. sites with NSTEMI in CRUSADE Registry from 2/15/2003 to 12/31/2006 linked to Medicare claims data Median follow-up 3.6 years In-hospital acute therapies and procedures, and discharge therapies were recorded in CRUSADE Long-term mortality data provided within Medicare claims data

  4. Methods – Statistical Analysis 1. Roe MT, Chen AY, Peterson ED. Predicting long-term mortality in older patients after non-st-segment elevation myocardial infarction: The crusade long-term mortality model and risk score. Am Heart J. 2011;162:875-883 • Smoking status at presentation: • Non-smokers • Recent/current smokers • Endpoint: 30-day and long-term mortality • Association between smoking status and 30-day and long-term mortality determined using Cox proportional hazards modeling • We used the CRUSADE mortality model for adjustment for key clinical factors1.

  5. Results – Patient Characteristics

  6. Results – In-hospital & discharge treatment *Medication within 24 hours of presentation

  7. Results – 30-day Mortality Unadjusted Adjusted HR = 0.83 95% CI = 0.75-0.92 HR = 1.08 95% CI = 0.97-1.20 Days Post-discharge Days Post-discharge Adjusted using CRUSADE mortality model

  8. Result – Long-term Mortality (Median 3.6 year) Unadjusted Adjusted HR = 0.92 95% CI = 0.88-0.97 HR = 1.28 95% CI =1.21-1.34 Years Post-discharge Years Post-discharge Adjusted using CRUSADE mortality model

  9. Limitations Observational study and unmeasured confounders that cannot be excluded No longitudinal data on smoking status, eg. smoking cessation status, intensity of smoking Did not examine geographic variations based on public ordinances bans on smoking

  10. Conclusions Similar to prior studies, smokers > 65 years were found to have paradoxically lower observed mortality after NSTEMI However after adjustment, long term mortality was worse for smokers than non-smokers Thus, efforts to encourage smoking cessation in this high-risk population remain essential, especially in older patients The importance of campaigns for smoking cessation should be enhanced, even in the era of contemporary ACS management

  11. Thank You

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