Impact of Smoking Status on Hospital Outcome of Patients with ST-Segment Elevation Myocardial Infarction Either Treated by Pharmacy-invasive Strategy or Primary  Percutaneous Coronary Intervention .

Abstract Background: Smoking is a common public problem with a high health burden. Many studies have shown that there are many hazardous actions of smoking on body systems especially haemostatic, respiratory and circulatory systems.Smoking may increase the thrombus burden in patients with acute coronary syndrome. The ‘smoker’s paradox’ has been described for more than 25 years. Its existence and its effect on patients’ outcome post myocardial infarction are debatable. So we conducted our study to assess the impact of smoking status on outcome of STEMI patients and efficacy of pharmaco-invasive strategy in treating STEMI patients compared to PPCI. Methods: We conducted our prospective observational study in the Cardiology department from-August 2018 to August 2019 on patients who are presented by STEMI with the duration from onset of symptoms to first medical contact were 12 hours or less we included 199 patients in our study.Patients are divided into 4 groups Group 1(Smokers treated by PPCI) Group 2 (Non-smokers treated by PPCI) Group 3 (Smoker treated by pharmaco-invasive strategy)Group 4 (Non-smoker treated by pharmaco-invasive strategy) TIMI flow before and after PCI, acute heart failure and death was assessed in each patient.Results:Smokers are younger than non-smokers and have fewer co-morbidities. Patients treated by primary PCI and pharmaco-invasive strategy either smokers and non-smokers there was no significant difference between the 4 groups in angiographic data and outcome except that smokers treated by pharmaco-invasive strategy had a lower incidence of TIMI flow III at diagnostic angiography before PCI with P value (0.047 ) Conclusion: There is no actual smokers paradox. Pharmaco-invasive strategy is a good option when a PPCI is not available. Finally, early transfer of smokers treated with a pharmaco-invasive strategy to a PCI capable hospital for early intervention may be recommended.