Smokers with ST-segment elevation myocardial infarction and short time to treatment have equal effects of PCI and fibrinolysis

Objectives: The purpose of this study was to examine the effect of primary percutaneous coronary intervention (PCI) compared to fibrinolysis in smokers and non-smokers with ST-segment elevation myocardial infarction (STEMI). Smokers seem to have less atherosclerosis but are more prone to thrombotic disease. Compared to non-smokers, they have higher rates of early, complete reperfusion when treated with fibrinolysis for MI. Methods and Results: In the Second Danish Multicenter Trial in Acute Myocardial Infarction (DANAMI-2), a total of 1572 patients with STEMI were randomized to either fibrinolysis or PCI (1129 patients were enrolled at 24 referral hospitals and 443 patients at 5 invasive treatment centers). The primary endpoint for this substudy was death by any cause. Secondary endpoints were a composite of death by any cause, clinical re-infarction or disabling stroke. Follow-up was 3 years. The effect of PCI is reported according to time to treatment and smoking status. Data on smoking habits were available for 1534 patients (895 smokers and 639 non-smokers). Smokers with short time to treatment (<3 hours) benefited equally from PCI and fibrinolysis with a trend toward higher mortality in the PCI group (mortality [hazard ratio, 1.64 (0.79-3.41); P≤.18], composite endpoint [hazard ratio, 1.06 (0.65-1.71); P≤.82]). In non-smokers with short time to treatment PCI was superior to fibrinolysis (mortality [hazard ratio, 0.46 (0.22-0.93); P≤.02], combined endpoint [hazard ratio, 0.45 (0.26-0.79); P≤.004]). Patients with >3 hours to treatment all showed a tendency toward a superior effect of PCI irrespective of smoking habits. Conclusions: PCI and fibrinolysis are equally beneficial in smokers with STEMI and short time to treatment.