TY - JOUR
T1 - Association of Smoking Cessation and Survival among Young Adults with Myocardial Infarction in the Partners YOUNG-MI Registry
AU - Biery, David W.
AU - Berman, Adam N.
AU - Singh, Avinainder
AU - Divakaran, Sanjay
AU - Defilippis, Ersilia M.
AU - Collins, Bradley L.
AU - Gupta, Ankur
AU - Fatima, Amber
AU - Qamar, Arman
AU - Klein, Josh
AU - Hainer, Jon
AU - Blaha, Michael J.
AU - Di Carli, Marcelo F.
AU - Nasir, Khurram
AU - Bhatt, Deepak L.
AU - Blankstein, Ron
N1 - Publisher Copyright:
© 2020 American Medical Association. All rights reserved.
PY - 2020/7/8
Y1 - 2020/7/8
N2 - Importance: Despite significant progress in primary prevention, the rate of myocardial infarction (MI) continues to increase in young adults.Objectives: To identify the prevalence of tobacco use and to examine the association of both smoking and smoking cessation with survival in a cohort of adults who experienced an initial MI at a young age.Design, Setting, and Participants: The Partners YOUNG-MI registry is a retrospective cohort study from 2 large academic centers in Boston, Massachusetts, that includes patients who experienced an initial MI at 50 years or younger. Smoking status at the time of presentation and at 1 year after MI was determined from electronic medical records. Participants were 2072 individuals who experienced an MI at 50 years or younger between January 2000 and April 2016. The dates of analysis were October to December 2019.Main Outcomes and Measures: Deaths were ascertained from the Social Security Administration Death Master File, the Massachusetts Department of Vital Statistics, and the National Death Index. Cause of death was adjudicated independently by 2 cardiologists. Propensity score-adjusted Cox proportional hazards modeling was used to evaluate the association between smoking cessation and both all-cause and cardiovascular mortality.Results: Among the 2072 individuals (median age, 45 years [interquartile range, 42-48 years]; 1669 [80.6%] men), 1088 (52.5%) were smokers at the time of their index hospitalization. Of these, 910 patients were further classified into either the cessation group (343 [37.7%]) or the persistent smoking group (567 [62.3%]) at 1 year after MI. Over a median follow-up of 11.2 years (interquartile range, 7.3-14.2 years), individuals who quit smoking had a statistically significantly lower rate of all-cause mortality (hazard ratio [HR], 0.35; 95% CI, 0.19-0.63; P < .001) and cardiovascular mortality (HR, 0.29; 95% CI, 0.11-0.79; P = .02). These values remained statistically significant after propensity score adjustment (HR, 0.30 [95% CI, 0.16-0.56; P < .001] for all-cause mortality and 0.19 [95% CI, 0.06-0.56; P = .003] for cardiovascular mortality).Conclusions and Relevance: In this cohort study, approximately half of individuals who experienced an MI at 50 years or younger were active smokers. Among them, smoking cessation within 1 year after MI was associated with more than 50% lower all-cause and cardiovascular mortality.
AB - Importance: Despite significant progress in primary prevention, the rate of myocardial infarction (MI) continues to increase in young adults.Objectives: To identify the prevalence of tobacco use and to examine the association of both smoking and smoking cessation with survival in a cohort of adults who experienced an initial MI at a young age.Design, Setting, and Participants: The Partners YOUNG-MI registry is a retrospective cohort study from 2 large academic centers in Boston, Massachusetts, that includes patients who experienced an initial MI at 50 years or younger. Smoking status at the time of presentation and at 1 year after MI was determined from electronic medical records. Participants were 2072 individuals who experienced an MI at 50 years or younger between January 2000 and April 2016. The dates of analysis were October to December 2019.Main Outcomes and Measures: Deaths were ascertained from the Social Security Administration Death Master File, the Massachusetts Department of Vital Statistics, and the National Death Index. Cause of death was adjudicated independently by 2 cardiologists. Propensity score-adjusted Cox proportional hazards modeling was used to evaluate the association between smoking cessation and both all-cause and cardiovascular mortality.Results: Among the 2072 individuals (median age, 45 years [interquartile range, 42-48 years]; 1669 [80.6%] men), 1088 (52.5%) were smokers at the time of their index hospitalization. Of these, 910 patients were further classified into either the cessation group (343 [37.7%]) or the persistent smoking group (567 [62.3%]) at 1 year after MI. Over a median follow-up of 11.2 years (interquartile range, 7.3-14.2 years), individuals who quit smoking had a statistically significantly lower rate of all-cause mortality (hazard ratio [HR], 0.35; 95% CI, 0.19-0.63; P < .001) and cardiovascular mortality (HR, 0.29; 95% CI, 0.11-0.79; P = .02). These values remained statistically significant after propensity score adjustment (HR, 0.30 [95% CI, 0.16-0.56; P < .001] for all-cause mortality and 0.19 [95% CI, 0.06-0.56; P = .003] for cardiovascular mortality).Conclusions and Relevance: In this cohort study, approximately half of individuals who experienced an MI at 50 years or younger were active smokers. Among them, smoking cessation within 1 year after MI was associated with more than 50% lower all-cause and cardiovascular mortality.
KW - Adult
KW - Case-Control Studies
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/mortality
KW - Propensity Score
KW - Registries
KW - Smoking/adverse effects
KW - Smoking Cessation/statistics & numerical data
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U2 - 10.1001/jamanetworkopen.2020.9649
DO - 10.1001/jamanetworkopen.2020.9649
M3 - Article
C2 - 32639567
AN - SCOPUS:85088206549
VL - 3
SP - e209649
JO - JAMA Network Open
JF - JAMA Network Open
SN - 2574-3805
IS - 7
M1 - e209649
ER -