The Correlation Between Cumulative Cigarette Consumption and Infarction-Related Coronary Spasm in Patients with ST-Segment Elevation Acute Myocardial Infarction Across Different Age Groups

Background: Coronary artery spasm (CAS) is a significant contributor to the pathogenesis of acute ST-elevation myocardial infarction (STEMI). Although smoking is a well-established risk factor for CAS, the relationship between cumulative cigarette consumption and infarction-related CAS across different age groups in STEMI patients remains unclear. This study aims to investigate how age modulates this correlation. Materials and Methods: We conducted a retrospective study of STEMI patients who underwent coronary angiography (CAG) at the General Hospital of Southern Theater Command from December 2014 to March 2018. Inclusion criteria were: patients aged 18 years or older with confirmed STEMI and CAS. Exclusion criteria included absence of CAG, significant comorbidities, and incomplete data. Patients were categorized into CAS and non-CAS groups and further stratified by age into young adults (≤45 years), middle-aged (46-59 years), and elderly (≥60 years). Cumulative cigarette consumption was assessed using the smoking index. Statistical analyses evaluated correlations between smoking and CAS by age group. The approval for this study was obtained from the Ethics Committee of General Hospital of Southern Theater Command (2018-54). Since data were evaluated retrospectively, anonymously, and solely obtained for the study purposes, a requirement of informed consent was waived by General Hospital of Southern Theater Command ethics committee. All study methods were performed in accordance with Helsinki Declaration. Ethical approval and consent to participate This study was approved by the ethics committee of General Hospital of Southern Theater Command (2018-54). Results: Of 1156 STEMI patients, 80 (6.9%) had CAS. The CAS group had a higher prevalence of young adults (35% vs. 13.8%, P < 0.001) and heavy smokers (62.5% in CAS vs. 46.6% in non-CAS, P < 0.001). Heavy smoking correlated with CAS in young adults (r = 0.321, P < 0.001) and middle-aged patients (r = 0.127, P = 0.006), but not in the elderly. Logistic regression revealed that heavy smoking significantly increased the risk of CAS, with adjusted odds ratios of 6.397 for grade 2 smokers and 6.926 for grade 3 smokers compared to non-smokers. Among heavy smokers, the risk of CAS was 4.912 times higher in young adults and 2.041 times higher in middle-aged patients compared to the elderly. Conclusion: Cumulative cigarette consumption is positively correlated with infarction-related CAS in STEMI patients. Heavy smoking is a major risk factor for CAS, especially in young and middle-aged individuals. Effective smoking control is essential for preventing and managing STEMI, particularly among younger and middle-aged populations in China.