SPC365

Impact of Active Smoking on the Timing and Presentation of First Acute Coronary Syndrome

Session: Sessão de Posters 46 - Síndromes coronárias agudas: vias, atrasos e impacto das recomendações
Speaker: Isabel Nóbrega Fernandes

Congress: CPC 2026
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type: Posters Eletrónicos
FP Number: ---
Authors: I Nóbrega Fernandes; I Martins Moreira; M Bernardo; L Sousa Azevedo; M Pipa; A Nunes; P Mateus; I Moreira

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Background: Cigarette smoking substantially accelerates the development of coronary atherosclerosis, leading many individuals to experience acute coronary events at a younger age than non-smokers. Describing how these patients present and the complications they develop during hospitalisation may help guide more effective prevention and cessation strategies.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Objective: To evaluate the influence of active smoking on the age at first acute coronary syndrome (ACS) and to compare clinical presentation and in-hospital evolution between active smokers and non-smokers.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Methods: We analysed all patients hospitalised with a first ACS between October 2010 and June 2025 in a single centre. Individuals were grouped according to current smoking status. Demographic variables, cardiovascular risk factors, presentation type, left ventricular function and in-hospital complications were evaluated. Predictors of younger ACS onset were identified using multivariate linear regression.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Results: Among 1,260 patients (mean age 66.6 &plusmn; 12.9 years; 28.7% women), 25.5% were active smokers. Smokers were predominantly men (86.0% vs. 66.3%, p&lt;0.001) and presented at a markedly younger age (55 vs. 71 years, p&lt;0.001). They had lower body mass index (26 vs. 27 kg/m&sup2;, p=0.002) and lower rates of hypertension (33.8% vs. 74.4%, p&lt;0.001), diabetes (10.4% vs. 34.9%, p&lt;0.001) and dyslipidaemia (50.2% vs. 60.8%, p&lt;0.001). Conversely, LDL cholesterol levels were higher on admission (126 vs. 110 mg/dL, p&lt;0.001), and a family history of coronary disease was more common (8.5% vs. 4.2%, p=0.003).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Active smokers more often presented with ST-elevation myocardial infarction (62.0% vs. 46.6%, p&lt;0.001) and with lower Killip class (Killip I: 92.8% vs. 85.0%, p&lt;0.001). Left ventricular ejection fraction at discharge was slightly lower (49% vs. 52%, p=0.025). New-onset heart failure (11.2% vs. 20.9%, p&lt;0.001) and atrial fibrillation (4.0% vs. 8.5%, p=0.008) occurred less frequently in smokers. Rates of reinfarction, cardiogenic shock, arrhythmic or mechanical complications, in-hospital mortality (0.6% vs. 2.1%, p=0.075) and one-year mortality (1.9% vs. 3.1%, p=0.250) did not differ between groups.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Active smoking independently predicted younger ACS onset, with a mean age reduction of 11.5 years (adjusted R&sup2; = 0.39, p&lt;0.001).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Conclusions: In this cohort, active smokers experienced ACS at a substantially younger age and more often with ST-elevation myocardial infarction. Despite these differences in baseline risk and presentation, in-hospital and one-year outcomes were comparable to those of non-smokers. These findings highlight the substantial influence of tobacco exposure on the early development of coronary disease and reinforce the need for targeted prevention and smoking cessation interventions in younger adults.</span></span></span></span></span></p>