Cardiac functional recovery after acute coronary syndrome: a comparison between smokers and non-smokers

    Authors

    Keywords

    acute coronary syndrome, smoking, cardiac functional recovery

    DOI

    https://doi.org/10.15836/ccar2026.41

    Full Text

    **Introduction:** Smoking is a well-established risk factor for the development of acute coronary syndrome (ACS). (1) Beyond its role in disease onset, smoking has been associated with adverse outcomes during follow-up. (2) While several studies have examined the impact of smoking cessation on cardiac recovery, few have directly compared smokers and non-smokers with respect to functional cardiac recovery following ACS. (3) The aim of this study was to evaluate differences in cardiac functional recovery between smokers and non-smokers after ACS. **Patients and Methods:** This retrospective study included patients hospitalized with ACS between January and December 2023. Patients were classified as smokers or non-smokers. Variables included demographics, comorbidities, MACE score, troponin, stenosis extent, hypokinesia, diastolic dysfunction, and echocardiographic changes. Analyses were performed using SPSS 26. Categorical variables were compared with Fisher’s exact or Chi-square tests, and continuous variables with Student’s t-test or Mann–Whitney U test. A two-tailed p 0.99† | | Hyperlipidemia | 17 (53.1) | 15 (46.9) | 32 (76.2) | 0.5 | | Hypertension | 13 (46.4) | 15 (53.6) | 28 (66.7) | 0.51 | | Diabetes mellitus | 5 (83.3) | 1 (16.7) | 6 (14.3) | 0.18† | | COPD | 2 (100) | 0 (0) | 2 (4.8) | 0.49† | [†] *χ2 test; †Fisher’s exact test ### TABLE 2: Comparison of cardiac recovery between smokers and non-smokers after acute coronary syndrome. | | **Median (IQR)** — **Smokers** | **Median (IQR)** — **Non-smokers** | **P*** | | --- | --- | --- | --- | | LVEF (%) | | | | | Baseline value | 55 (45-62) | 57 (45-60) | 0.6 | | Follow-up value | 60 (52-62) | 60 (49-67) | 0.6 | | Left ventricle (cm) | | | | | Baseline value | 51 (45-53) | 52 (46-56) | 0.7 | | Follow-up value | 54 (46-56) | 52 (48-54) | 0.8 | | Left atrium (cm) | | | | | Baseline value | 42 (38-43) | 42 (36-45) | >0.9 | | Follow-up value | 42 (38-43) | 39 (35-43) | 0.2 | [†] * Mann Whitney U test FIGURE 1. Change in left ventricular ejection fraction (LVEF; %) over time (initial vs. follow-up) in smokers and non-smokers. FIGURE 2. Change in left ventricular (LV) and left atrial (LA) dimensions (cm) over time (initial vs. follow-up) in smokers and non-smokers. **Conclusion:** This study found no statistically significant difference in cardiac recovery after ACS between smokers and non-smokers. However, a trend toward less favorable remodeling in smokers was observed. Given the small sample size and self-reported smoking status, further larger studies are needed to confirm these findings and clarify the clinical impact.

    Literature

    1. Abusharekh M, Kampf J, Dykun I, Backmann V, Jánosi RA, Totzeck M, et al. Impact of smoking on procedural outcomes and all-cause mortality following acute myocardial infarction: A misleading early-stage pseudoparadox with ultimately reduced survival. Int J Cardiol Cardiovasc Risk Prev. 2024 September 27;23:200336. https://doi.org/10.1016/j.ijcrp.2024.200336
    2. Yoo JE, Jeong SM, Yeo Y, Jung W, Yoo J, Han K, et al. Smoking Cessation Reduces the Risk of Heart Failure: A Nationwide Cohort Study. JACC Heart Fail. 2023 March;11(3):277–87. https://doi.org/10.1016/j.jchf.2022.07.006
    3. Janjani P, Azimivaghar J, Salehi N, Haidari Moghadam R, Shakiba M, Siabani S, et al. Effect of Smoking Cessation on Left Ventricular Ejection Fraction after Acute ST Elevation Myocardial Infarction. ARYA Atheroscler. 2023 February;19(2):1–7. https://doi.org/10.48305/ARYA.2022.11895.2734
    Cardiologia Croatica
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    Cardiac functional recovery after acute coronary syndrome: a comparison between smokers and non-smokers

    Extended Abstract
    Issue1-2
    Published
    Pages41-42
    PDF via DOIhttps://doi.org/10.15836/ccar2026.41
    acute coronary syndrome
    smoking
    cardiac functional recovery

    Authors

    Ana Kovačević*ORCIDGeneral Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia
    Stjepan KovačevićORCIDGeneral Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia
    Iva DumančićORCIDGeneral Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia
    Marijana KovačevićGeneral Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia
    Maja FranićORCIDGeneral Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia
    Josipa MeterORCIDGeneral Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia
    Nikolina BukalORCIDGeneral Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia
    Ninoslav LekoORCIDGeneral Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia
    Katica Cvitkušić LukendaORCIDGeneral Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia

    *Correspondence email: ana.bardak@gmail.com

    Full Text

    Introduction: Smoking is a well-established risk factor for the development of acute coronary syndrome (ACS). (1) Beyond its role in disease onset, smoking has been associated with adverse outcomes during follow-up. (2) While several studies have examined the impact of smoking cessation on cardiac recovery, few have directly compared smokers and non-smokers with respect to functional cardiac recovery following ACS. (3) The aim of this study was to evaluate differences in cardiac functional recovery between smokers and non-smokers after ACS.

    Patients and Methods: This retrospective study included patients hospitalized with ACS between January and December 2023. Patients were classified as smokers or non-smokers. Variables included demographics, comorbidities, MACE score, troponin, stenosis extent, hypokinesia, diastolic dysfunction, and echocardiographic changes. Analyses were performed using SPSS 26. Categorical variables were compared with Fisher’s exact or Chi-square tests, and continuous variables with Student’s t-test or Mann–Whitney U test. A two-tailed p < 0.05 was considered significant.

    Results: The study included 42 patients. The mean age of smokers was 61.4 years (SD 12.1) and 67.0 years (SD 7.9) for non-smokers (Student’s t-test, p = 0.09; 95% CI: −0.8 to 11.9). Among smokers, the median pack-years was 33 (IQR 24–50). Baseline and clinical characteristics (Table 1) and echocardiographic parameters (Table 2) showed no significant differences between groups. Although non-smokers showed greater improvement in left ventricular ejection fraction (LVEF) (mean Δ 4.6%, SD 6.9) compared to smokers (mean Δ 1.4%, SD 13.3), the difference was not statistically significant (Student’s t-test, p = 0.3; 95% CI: −3.5 to 9.8) (Figure 1). A slight, non-significant increase in left ventricular (LV) dimension was observed in smokers (median Δ 1 cm, IQR −2 to 4; Mann–Whitney U test, p = 0.4), suggesting a possible trend toward adverse LV remodeling (Figure 2). Left atrial (LA) dimension remained unchanged in both groups.

    TABLE 1: Baseline and clinical characteristics according to smoking status.

    Gender
    Male
    N (%) — Smokers
    13 (44.8)
    N (%) — Non-smokers
    16 (55.2)
    N (%) — Total
    29 (69)
    P*
    0.32
    Female
    N (%) — Smokers
    8 (61.5)
    N (%) — Non-smokers
    5 (38.5)
    N (%) — Total
    13 (31)
    Coronary stenosis
    Single-vessel disease
    N (%) — Smokers
    10 (58.8)
    N (%) — Non-smokers
    7 (41.2)
    N (%) — Total
    17 (40.5)
    P*
    0.35
    Multivessel disease
    N (%) — Smokers
    11 (44)
    N (%) — Non-smokers
    14 (56)
    N (%) — Total
    25 (59.5)
    Improved hypokinesia
    N (%) — Smokers
    3 (37.5)
    N (%) — Non-smokers
    5 (62.5)
    N (%) — Total
    8 (19)
    P*
    0,7†
    Improved diastolic dysfunction
    N (%) — Smokers
    1 (33.3)
    N (%) — Non-smokers
    2 (66.7)
    N (%) — Total
    3 (7.1)
    P*
    >0.99†
    Hyperlipidemia
    N (%) — Smokers
    17 (53.1)
    N (%) — Non-smokers
    15 (46.9)
    N (%) — Total
    32 (76.2)
    P*
    0.5
    Hypertension
    N (%) — Smokers
    13 (46.4)
    N (%) — Non-smokers
    15 (53.6)
    N (%) — Total
    28 (66.7)
    P*
    0.51
    Diabetes mellitus
    N (%) — Smokers
    5 (83.3)
    N (%) — Non-smokers
    1 (16.7)
    N (%) — Total
    6 (14.3)
    P*
    0.18†
    COPD
    N (%) — Smokers
    2 (100)
    N (%) — Non-smokers
    0 (0)
    N (%) — Total
    2 (4.8)
    P*
    0.49†

    *χ2 test; †Fisher’s exact test

    TABLE 2: Comparison of cardiac recovery between smokers and non-smokers after acute coronary syndrome.

    LVEF (%)
    Baseline value
    Median (IQR) — Smokers
    55 (45-62)
    Median (IQR) — Non-smokers
    57 (45-60)
    P*
    0.6
    Follow-up value
    Median (IQR) — Smokers
    60 (52-62)
    Median (IQR) — Non-smokers
    60 (49-67)
    P*
    0.6
    Left ventricle (cm)
    Baseline value
    Median (IQR) — Smokers
    51 (45-53)
    Median (IQR) — Non-smokers
    52 (46-56)
    P*
    0.7
    Follow-up value
    Median (IQR) — Smokers
    54 (46-56)
    Median (IQR) — Non-smokers
    52 (48-54)
    P*
    0.8
    Left atrium (cm)
    Baseline value
    Median (IQR) — Smokers
    42 (38-43)
    Median (IQR) — Non-smokers
    42 (36-45)
    P*
    >0.9
    Follow-up value
    Median (IQR) — Smokers
    42 (38-43)
    Median (IQR) — Non-smokers
    39 (35-43)
    P*
    0.2

    * Mann Whitney U test

    FIGURE 1. Change in left ventricular ejection fraction (LVEF; %) over time (initial vs. follow-up) in smokers and non-smokers.

    FIGURE 2. Change in left ventricular (LV) and left atrial (LA) dimensions (cm) over time (initial vs. follow-up) in smokers and non-smokers.

    Conclusion: This study found no statistically significant difference in cardiac recovery after ACS between smokers and non-smokers. However, a trend toward less favorable remodeling in smokers was observed. Given the small sample size and self-reported smoking status, further larger studies are needed to confirm these findings and clarify the clinical impact.

    Literature

    1. 1.
      Abusharekh M, Kampf J, Dykun I, Backmann V, Jánosi RA, Totzeck M, et al. Impact of smoking on procedural outcomes and all-cause mortality following acute myocardial infarction: A misleading early-stage pseudoparadox with ultimately reduced survival. Int J Cardiol Cardiovasc Risk Prev. 2024 September 27;23:200336.DOI
    2. 2.
      Yoo JE, Jeong SM, Yeo Y, Jung W, Yoo J, Han K, et al. Smoking Cessation Reduces the Risk of Heart Failure: A Nationwide Cohort Study. JACC Heart Fail. 2023 March;11(3):277–87.DOI
    3. 3.
      Janjani P, Azimivaghar J, Salehi N, Haidari Moghadam R, Shakiba M, Siabani S, et al. Effect of Smoking Cessation on Left Ventricular Ejection Fraction after Acute ST Elevation Myocardial Infarction. ARYA Atheroscler. 2023 February;19(2):1–7.DOI