What is the clinical evidence from this study?

Study design: Observational. Population: Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) (n=6045). Intervention: Smoking vs. Non-smoking. Primary outcome: 36-month all-cause mortality (HR 1.23, 95% CI 1.03-1.47, p=0.02).

What question did this study set out to answer?

To explore the relationship between smoking and 36-month mortality outcomes in patients with myocardial infarction and non-obstructive coronary arteries.

March 21, 2026Open Access

Impact of smoking on outcomes in patients with Myocardial Infarction with Non-Obstructive Coronary Arteries — an observational study

Key Result

After adjusting for baseline differences, smoking was an independent risk factor for 36-month mortality (HR 1.23) in patients with myocardial infarction with non-obstructive coronary arteries.

Key Points

To explore the relationship between smoking and 36-month mortality outcomes in patients with myocardial infarction and non-obstructive coronary arteries.
Conducted an observational study
Compared crude rates of death between smokers and non-smokers
Controlled for traditional risk factors and age
Smokers had lower 36-month mortality rates compared to non-smokers
Tobacco use was identified as an independent risk factor for mortality after controlling for baseline differences
Younger age and lower burden of risk factors contributed to better outcomes in smokers

Study Design

Type

Observational

Multicenter

Yes

Structured PICO

Does current smoking impact all-cause mortality and MI in patients with MINOCA?

Population

Patients hospitalized with a working diagnosis of MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries)

Intervention

Current smoking

Comparator

Non-smokers

Outcome

All-cause mortality and MIhard clinical

Smoking is an independent risk factor for long-term mortality in MINOCA patients, and the apparent 'smoker's paradox' of lower crude mortality is driven by the younger age and fewer comorbidities of smokers.

Limitations

Retrospective and observational study design
Inability to clearly differentiate between smokers and non-smokers due to secondhand smoke and ambient air pollution
Lack of precise data on patients' tobacco exposure or pack-years
No information about tobacco dependence treatment and smoking cessation during follow-up
Broad definition of MINOCA applied without data on additional testing (IVUS, OCT, FFR) to identify the primary cause
Lack of information on invasive microvascular measurements and provocative spasm tests
Incomplete data on specific causes of death (cardiovascular vs. cancer-related)
Lack of data regarding drug therapy effectiveness during the follow-up period

Abstract

This study showed that lower 36‑month crude rates of death among the smokers (comparing to non-smokers) may be explained by a significantly lower burden of traditional risk factors and younger age of smokers. After adjusting for baseline differences, tobacco use remained an independent risk factor for 36‑month mortality.

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Discussion

Authors

Maciej Koźlik

Aneta Desperak

Marta Bujak

Journals

Kardiologia Polska

Actions

Institutions

Keele University

Medical University of Silesia

University of Opole

References and Citations

Connected Papers

Building similarity graph...

Analyzing shared references across papers

Impact of smoking on outcomes in patients with Myocardial Infarction with Non-Obstructive Coronary Arteries — an observational study

Key Result

Key Points

Study Design

Structured PICO

Limitations

Abstract

Citation Network

Connected Papers

Discussion

Authors

Journals

Actions

Institutions

References and Citations

Citation Network

Connected Papers

Discussion

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