IMPACT OF SMOKELESS TOBACCO USE ON DISTRIBUTION OF VESSEL INVOLVEMENT IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Abstract

Objectives: Despite widespread use of smokeless tobacco (ST) in Pakistan, a very limited empirical evidence have been reported regarding its impact on the coronary anatomy and obstructions. Therefore, this study was conducted to compare the coronary angiographic profile of smokeless tobacco (ST) users and smokers with non-tobacco users presented with acute myocardial infarction (AMI). Methodology: Consecutive patients with AMI were stratified in to four groups as tobacco non-users (G1), solo ST users (G2), both smoking and ST users (G3), and solo smokers (G4). Coronary angiographic findings regarding number of diseases vessels and infarct related artery were recorded. Results: Out of 326 patients, ST users were 28.2%(92), 6.4%(21) in conjunction with smoking and reaming 21.8%(71) without smoking. Females were 19.7%(14/71) of G2, 4.8%(1/21) of G3, 0% in G4. Young patients (≤ 40 years) were 3.4%(5/149) of G1, 9.9%(7/71) of G2, 14.1%(12/85) of G4, and 23.8%(5/21) of G3 cumulatively making 82.8%(24/29) of the young patients. Single vessel disease (SVD) and left anterior descending artery (LAD) were significantly higher among ST user as compared to non-users with distribution of 46.7% vs. 34.2% and 70.7% vs. 56.4% respectively. Conclusion: The distribution and localization of involved vessels among ST users with AMI are same as that of smokers with SCD and LAD as infarct artery as the common findings. Tendency of ST use is also high among female patients and Tobacco use in either form, smoking or smokeless, is alarmingly high (>80%) among young (≤40 years) patients with AMI.