Table 1
Characteristics and pre-hospital and in-hospital treatments of smokers and non-smokers with ACS.
| Smokers (N = 37,750) | Non-smokers (N = 54,759) | P value | |
|---|---|---|---|
| Age, mean (SD), years | 59.1 (11.8) | 66.6 (11.9) | <0.001 |
| Women, % (n/N) | 5.1 (1,937/37,750) | 40.5 (22,201/54,759) | <0.001 |
| Vital signs | |||
| SBP levels, mean (SD), mmHg | 128.5 (23.0) | 132.2 (23.7) | <0.001 |
| DBP levels, mean (SD), mmHg | 78.6 (14.6) | 78.1 (14.2) | <0.001 |
| Heart rates, mean (SD), bpm | 76.8 (15.8) | 78.0 (16.6) | <0.001 |
| Risk factors | |||
| Hypertension, % (n/N) | 60.1 (22,703/37,750) | 70.1 (38,375/54,759) | <0.001 |
| Diabetes mellitus, % (n/N) | 40.0 (15,097/37,750) | 47.9 (26,208/54,759) | <0.001 |
| Elevated LDL-C, % (n/N) | 54.2 (20,473/37,750) | 51.2 (28,029/54,759) | <0.001 |
| Low HDL-C, % (n/N) | 49.3 (18,608/37,750) | 40.3 (22,086/54,759) | <0.001 |
| Elevated TG, % (n/N) | 23.6 (8,902/37,750) | 20.0 (1,0957/54,759) | <0.001 |
| History of diseases | |||
| ACS, % (n/N) | 9.1 (3,427/37,750) | 13.3 (7,299/54,759) | <0.001 |
| Heart failure, % (n/N) | 1.1 (398/37,750) | 3.1 (1,672/54,759) | <0.001 |
| Atrial fibrillation, % (n/N) | 1.3 (501/37,750) | 3.2 (1,728/54,759) | <0.001 |
| Cerebrovascular disease, % (n/N) | 7.1 (2,685/37,750) | 10.4 (5,702/54,759) | <0.001 |
| Family history of CHD, % (n/N) | 3.6 (1,341/37,750) | 2.1 (1,140/54,759) | <0.001 |
| Critical cardiac symptoms at admission, % (n/N) | 8.3 (3,144/37,750) | 10.2 (5,576/54,759) | <0.001 |
| Killip class, % (n/N) | <0.001 | ||
| II–III | 20.4 (7,710/37,750) | 24.7 (13,509/54,759) | |
| IV | 4.2 (1,600/37,750) | 5.0 (2,760/54,759) | |
| Substantially elevated myocardial injury markers, % (n/N) | 86.1 (32,510/37,750) | 83.0 (45,468/54,759) | <0.001 |
| ACS type | <0.001 | ||
| STEMI, % (n/N) | 67.8 (25,589/37,750) | 54.8 (29,986/54,759) | |
| NSTE-ACS, % (n/N) | 32.2 (12,161/37,750) | 45.2 (24,773/54,759) | |
| Renal insufficiency, % (n/N) | 44.6 (16,844/37,750) | 61.4 (33,610/54,759) | <0.001 |
| Triple-vessel disease, % (n/N)‖ | 19.3 (5,534/28,682) | 21.1 (7,568/35,875) | <0.001 |
| Pre-hospital statin, % (n/N) | 15.2 (5,734/37,750) | 19.3 (10,570/54,759) | <0.001 |
| Pre-hospital ACEI/ARB, % (n/N) | 8.4 (3,163/37,750) | 11.9 (6,533/54,759) | <0.001 |
| Pre-hospital beta-blockers, % (n/N) | 7.7 (2,917/37,750) | 10.9 (5,956/54,759) | <0.001 |
| Patients with referral, % (n/N) | 46.6 (17,581/37,750) | 38.0 (20,779/54,759) | <0.001 |
| Medical therapy | |||
| DAPT, % (n/N) | 95.2 (35,782/37,588) | 89.9 (48,723/54,223) | <0.001 |
| Statins, % (n/N) | 94.8 (35,740/37,700) | 92.8 (50,709/54,670) | <0.001 |
| ACEI/ARB, % (n/N) | 49.8 (17,794/35,726) | 50.0 (25,890/51,775) | 0.565 |
| Beta-blockers, % (n/N) | 58.7 (21,343/36,341) | 57.8 (30,508/52,832) | 0.003 |
| PCI, % (n/N) | 77.9 (29,391/37,750) | 64.8 (35,508/54,759) | <0.001 |
[i] ACEI: angiotensin-converting enzyme inhibitor; ACS: acute coronary syndrome; ARB: angiotensin-receptor blocker; CHD: coronary heart disease; DAPT: dual antiplatelet therapy; DBP: diastolic blood pressure; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; NSTE-ACS: non-ST-elevation acute coronary syndrome; PCI: percutaneous coronary intervention; SBP: systolic blood pressure; STEMI: ST-elevation myocardial infarction; TG: triglyceride.
‖ Triple-vessel disease was not available for 27,952 (30.2%) patients.
The usage rate of drugs was calculated in patients without drug contraindications.
Figure 1
Smoking prevalence among ACS patients by sex and age. Smoking prevalence over the entire study period among different age groups among male ACS patients (blue) and female ACS patients (red). ACS: acute coronary syndrome.
Figure 2
Multivariable analysis of association between smoking and critical cardiac symptoms at admission and in-hospital outcomes among ACS patients. This forest plot shows patients’ critical cardiac symptoms at admission and in-hospital outcomes according to smoking status among all ACS patients, and among patients by subtypes of ACS, using data from the CCC-ACS project. Critical cardiac symptoms at admission included acute heart failure, cardiogenic shock, and cardiac arrest. ACS: acute coronary syndrome; CI: confidence interval; NSTE-ACS: non-ST-elevation acute coronary syndrome; OR: odds ratio; STEMI: ST-elevation myocardial infarction.
Figure 3
Rates of provision of different types of smoking cessation interventions. Rates of provision of different smoking cessation interventions before discharge for the entire study period among all smokers with ACS who survived to discharge. ‡ Provided any two or more above smoking cessation interventions.
Figure 4
Comparison of patients receiving smoking cessation interventions and medications for secondary prevention before discharge. Proportion of patients receiving smoking cessation interventions and other ACS quality of care measures for the entire study period among all smoking ACS patients before discharge. ACEI: angiotensin-converting enzyme inhibitor; ACS: acute coronary syndrome; ARB: angiotensin-receptor blocker.