Résumé
Background: Although the number of women who smoke is growing among patients with ST-segment elevation myocardial infarction (STEMI), this population is poorly documented.
Aim: Using a French nationwide MI cohort, we aimed to analyze gender-specific characteristics and hospital outcomes of active smokers hospitalized for acute STEMI.
Methods: The French Cohort of Myocardial Infarction Evaluation (FRENCHIE) is a large ongoing AMI cohort, collecting data from all patients hospitalized for AMI within 48 h of symptom onset in 21 French centers. STEMI patients admitted from 2019 to 2022 were analyzed. Smoking status was self-declared. Past or never smokers were excluded from the analysis. Combined in-hospital events included death or ventricular fibrillation (VF).
Results: Among the 9258 STEMI patients, 3761 (40.6%) were current smokers, of whom 702(18.7%) were women. Women were in average 4 years older than men (57.9 ± 11.0 vs 54.3 ± 10.0 y, p<.0001), and had higher rates of cardiovascular (CV) risk factors including hypertension (p<.0001), familial history of CAD (p=0.02), obesity (p=0.001), and co-morbidities such as respiratory failure (p=0.001) or systemic auto-immune diseases (p<.0001). However, they were 3 times less likely to use illicit drugs (p<.0001). The rate of peripheral artery disease was similar for both genders, while history of CAD was lower in women (8.5% vs 12.4%, p=0.004). Their left ventricular ejection fraction was higher (49.3 ± 10.6% vs 47.8 ± 10.7 %, p=0.002). Chest pain was the most prevalent symptom in both genders, but women more frequently exhibited atypical chest pain (12.5% vs. 7.5%, p<.0001). Additionally, syncope was almost twice more common in women (6.4 vs. 3.6%, p=0.0007). Although the difference was not significant, there was a trend toward higher mortality or VF in women (5.6 vs. 4.3%, p=0.1671), which persisted after adjustment for confounding factors (OR(95%CI): 1.46 (0.94 ; 2.27), p=0.0940).
Conclusion: Our contemporary findings in smokers with STEMI showed that women present with specific characteristics including an older age, an elevated burden of CV risk factors and more atypical chest pain or syncope. The rate of death or FV in women who smoke was higher than their male counterpart, although not reaching significance.
FRENCHIE was supported in part by the RHU iVASC grant ANR-16-RHUS-00010 from the French National Research Agency (ANR) as part of the Investissements d'Avenir program.