Comparison of case fatality in smokers and non-smokers after acute cardiac event.

Although smoking is a major modifiable risk factor for acute myocardial infarction, it has also been associated with an up to twofold lower risk of dying in hospital after an acute myocardial infarction.1 2 We analysed data from a community based register of coronary heart disease to determine whether differences in case fatality (the proportion of those dying) between smokers and non-smokers are restricted to patients who have been admitted to hospital and to evaluate possible explanations for this smoker's paradox. All deaths related to coronary causes and all admitted patients aged 25–64 who met predefined criteria for myocardial infarction or coronary death were identified in Auckland, New Zealand, between 1986 and 1992 as part of the World Health Organisation MONICA (monitoring trends and determinants in cardiovascular disease) project. Study criteria, and methods of case finding and …