Page 175 - Livre électronique des Rencontres Franco-Tunisiennes de Pneumologie 2019

P123. ACUTE CORONARY SYNDROME AMONG SMOKERS

R.GARGOURI 1, S. MSAAD 1, M. BEN HALIMA 2, O.GUERMAZI 2, S.BOUDICHE 2, K.SAMMOUD
2, M. MECHRI 2, A.FARHATI 2, N. LARBI 2, F. MGHAIETH 2, S.OUALI 2, MS. MOURALI 2, S.
KAMMOUN 1

1. SERVICE DE PNEUMOLOGIE ET D’ALLERGOLOGIE CHU HEDI CHAKER SFAX 2. SERVICE DES EXPLORATIONS
FONCTIONNELLES ET DE REANIMATION CARDIOLOGIQUE. HOPITAL LA RABTA

Introduction
Smokers are surely at higher risk of developing coronary artery diseases, but they have better
short-term survival after myocardial infarction. It is the smoker’s paradox. Unfortunately, 2/3 of
patients who quit smoking after ACS return to smoking within 1 year.

Aim

To determine the clinical and the therapeutic particularities of ACS in Tunisian smokers.
Method

A comparative study including 58 smokers (G 1) and 42 non-smokers (G 2), admitted from July 2018
to October 2018 at the cardiology department in La Rabta university hospital, with a diagnosis of
acute coronary syndrome. Smoking dependence was evaluated by Fagerstrom inventory. One-
year mortality and smoking status were obtained by either phone contacts or clinic visits.
Result

The study sample consisted of 100 patients with acute coronary syndromes. For G1, cigarettes
consumption was the most frequent type of smoking (86%). Mean duration of smoking was
30,93±10,9 years. The patients of G1 were mostly at high and very high nicotinic dependency (78%),
and average dependency according to the Fagerstrom test was 6,5±1,5Low economic level was
noted in 61% of patients and they were mostly from G1(p=0,006). Patients were admitted for
NSTEMI in 50% of cases, and it was significantly more frequent among non-smokers (p=0,002).
Smokers were mostly diagnosed with AMI (p=0,001). Mean age was 56(±9,64) years with extreme
ranging from 33 to 79 years old for G1 and was 64(±8,47) years with extreme ranging from 46 to 81
years old for G2. All patients from G1 were men, while more than a half of G2 (66,7%) were female.
Non-smokers were more likely to have a history of stable angina (7,14%) or NSTEMI (16,66%) than
smokers, whose were more likely to have STEMI history (12%). Even though, coronary artery bypass
graft was significantly more performed in G2 (p=0,008). G1 patients had fewer cardiovascular risk
factors than G2 such as hypertension (p=0,03), dyslipidemia (p=0,01), obesity (p=0,01) and diabetes
mellitus (0,001). Nevertheless, patients from G1 had more COPD (10,34%). During the current ACS,
typical chest pain was noted in 91% cases in G 1. At admission, the highest proportion of patients
in Killip class >1 was in G2 (21,42%) compared with G1 (6,89%). G1 had higher peak serum CK-MB
fraction (p=0,009). Median serum high sensitivity troponin level was higher in G1 (1245 ng/ml)
compared to G2 (504 ng/ml). Anemia was more frequent in G2 (p=0,003). Smokers were more likely

Pag e 174