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Q J Med 1999; 92: 679-681
© 1999 Association of Physicians

Correspondence

Lower cardiac mortality in smokers following thrombolysis

D.E. Newby and N.A. Boon

Department of Cardiology, Royal Infirmary, Edinburgh

Sir,

In their recent paper,1 Purcell and colleagues confirm earlier observations that, in comparison to non-smokers, smokers have a higher frequency of reperfusion with thrombolytic therapy and consequently have a lower in-hospital mortality during acute myocardial infarction—the so-called `smokers' paradox'. The authors conclude that `smokers may have enhanced systemic fibrinolysis following thrombolysis in acute myocardial infarction'. We believe that this conclusion is not supported by the data, and that alternative and more likely explanations can explain the smokers' paradox.

The authors cite 1-h plasma fibrinogen concentrations as a surrogate marker of the effectiveness of systemic fibrinolysis following thrombolytic therapy with streptokinase. However, although they state that `...current smokers as a group are less likely than non-smokers to have . . . [Full Text of this Article]

References

I. Purcell and M. Farrer

Cardiac Medicine, National Heart and Lung Institute, London


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