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Gender and Smoking-Related Survival Differences in Patients with ST-Elevation Myocardial Infarction


avatar Parisa Janjani ORCID 1 , avatar Sayeh Motevaseli ORCID 1 , avatar Yahya Salimi ORCID 2 , avatar Soraya Siabani ORCID 1 , avatar Atiyeh Asadmobini ORCID 1 , avatar Nahid Salehi ORCID 1 , *

1 Cardiovascular Research Center, Health Research Institute, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran

2 Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, IR Iran

How to Cite: Janjani P, Motevaseli S, Salimi Y, Siabani S, Asadmobini A, et al. Gender and Smoking-Related Survival Differences in Patients with ST-Elevation Myocardial Infarction. Int Cardio Res J. 2022;16(3):e128157.


International Cardiovascular Research Journal: 16 (3); e128157
Published Online: September 30, 2022
Article Type: Research Article
Received: May 19, 2022
Revised: August 15, 2022
Accepted: September 07, 2022


Background: Smoking is the leading cause of preventable death. Female smokers bear
a greater risk of experiencing an ST-segment elevation myocardial elevation (STEMI)
than male smokers.
Objectives: This study aimed to investigate gender and smoking-related survival
differences one-year post-STEMI.
Methods: This registry-based cohort study included all STEMI patients of Imam Ali
Hospital, Kermanshah, Iran. All eligible adult patients with STEMI were enrolled.
Baseline data and one-year post-STEMI data were collected. Cox proportional models
were used to estimate crude and full-adjusted hazard ratios (HRs) with 95% confidence
intervals (95% CIs). All analyses were performed using Stata.
Results: During 2080.9 person-years, 22 patients were lost to follow-up (success rate =
99%). There were 2,279 STEMI patients (22.99% women) during the study period. Men
were younger than women (58.50 ± 12.22 vs. 65.26 ± 11.56 years, P ˂ 0.001). In men,
smoking was a protective factor against in-hospital mortality in the unadjusted model
(HR = 0.49, 95% CI: 0.31 – 0.78, P = 0.002), but was not a protective factor after adjusting
for age, hypertension, dyslipidemia, diabetes, creatine kinase-MB, body-mass index,
LDL-cholesterol, HDL-cholesterol, glomerular filtration rate, anterior wall MI/LBBB,
left ventricular ejection fraction and reperfusion therapy (HR = 0.66, 95% CI: 0.34 –
1.25, P = 0.198).
Conclusions: Although male smokers with STEMI had a lower in-hospital mortality
rate, this difference did not persist in the adjusted model. Thus, the smokers’ paradox
phenomenon was not proven. The better outcomes of men with STEMI compared to
women are probably related to their younger age and fewer risk factors at the time of


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