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Smoking increases reinfarction rate after thrombolytics and conservative therapy for acute myocardial infarction

Cigarette smoking was the only baseline variable predictive of reinfarction in patients who received IV streptokinase 1.5MU (n = 315) or alteplase lOOmg in divided doses (141), within 6 hours of onset of ischaemic pain. During the 12-month follow-up period, reinfarction occurred in 12.5% of smokers vs 6.3% of nonsmokers. More importantly, patients who stopped smoking after the initial infarction were less likely to experience reinfarction than those who continued (5.1 vs 20% reinfarcted, respectively). Overall clinical reinfarction rates were 4.8% at 30 days and 8.6% at I year and there was no significant difference between streptokinase and alteplase recipients. The severity of reinfarction appeared to be reduced in 4/13 patients who received further prompt treatment with streptokinase or aiteplase compared with those who reinfarcted but were not retreated with thrombolytics.

The patients were managed conservatively after thrombolysis; heparin, aspirin, dipyridamole and beta blockers were all used routinely in the absence of contraindications. Only patients with left main coronary artery stenosis and those with symptoms refractory to medical intervention were treated surgically (4.2% of patients within the first 42 days). Riven JT. White HD. Cross DB. Williams BF. Norris RM. Reinfarction after thrombolytic therapy for acute myocardial infarction followed by conservative mansement: incidence and effect of smokinJ. Journal ofthe American Col. of Cardiology 16: J40.348. Aql~ _

_ 20 Oct 1990 INPHARMA® ISSN 0156-2703/90/1020-0016/0$01.00/0 <E> Mil laterrunioNl uti