La paradoja del tabaco en el síndrome coronario agudo: El abandono previo del hábito tabáquico como marcador de mejor pronóstico a corto plazo

espanolObjetivo La paradoja del tabaco es un fenomeno insuficientemente explicado en estudios previos. Este estudio analiza el papel pronostico del tabaquismo previo o activo en pacientes con sindrome coronario agudo. Metodos Obtuvimos los datos del registro ARIAM, entre 2001 y 2012. Se incluyo a 42.827 pacientes con sindrome coronario agudo (edad media 65 ± 13 anos, 26,4% mujeres). Se analizo la influencia del habito tabaquico o de la condicion de exfumador en la mortalidad mediante analisis multivariados. Resultados Los fumadores eran mas jovenes, mas frecuentemente hombres, tenian menos diabetes, hipertension e historia previa de insuficiencia cardiaca, ictus, arritmia e insuficiencia renal, asi como mas frecuentemente elevacion del ST e historia familiar. Los exfumadores presentaban mas dislipidemia e historia de angina, infarto de miocardio, cardiopatia isquemica, vasculopatia periferica y broncopatia cronica. Fumadores y exfumadores desarrollaron menos frecuentemente shock cardiogenico (fumadores 4,2%, exfumadores 4,7% y no fumadores 6,9%, p Conclusiones La paradoja del tabaco es un hallazgo que puede explicarse por otros factores pronosticos. El abandono del habito tabaquico previo a un ingreso por sindrome coronario agudo se asocia a un mejor pronostico. EnglishObjective The tobacco paradox is a phenomenon insufficiently explained by previous studies. This study analyses the prognostic role of prior or active smoking in patients with acute coronary syndrome. Methods We obtained data from the ARIAM registry, between 2001 and 2012. The study included 42,827 patients with acute coronary syndrome (mean age, 65 ± 13 years; 26.4% women). The influence of smoking and that of being an ex-smoker on mortality was analysed using a multivariate analysis. Results The smokers were younger, were more often men, had less diabetes, hypertension and prior history of heart failure, stroke, arrhythmia and renal failure and more frequently had ST-elevation and a family history of smoking. The ex-smokers had more dyslipidaemia and history of angina, myocardial infarction, ischemic heart disease, peripheral vasculopathy and chronic bronchial disease. Smokers and ex-smokers less frequently developed cardiogenic shock (smokers 4.2%, ex-smokers 4.7% and nonsmokers 6.9%, P Conclusions The tobacco paradox is a finding that could be explained by other prognostic factors. Smoking cessation prior to hospitalization for acute coronary syndrome is associated with a better prognosis.