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Carbon monoxide and prognosis in smokers hospitalised with acute cardiac events: a multicentre, prospective cohort study

2024; Elsevier BV; Volume: 67; Linguagem: Inglês

10.1016/j.eclinm.2023.102401

2589-5370

Jean‐Guillaume Dillinger, Théo Pezel, Clément Delmas, Guillaume Schurtz, Antonin Trimaille, Nicolas Piliero, Claire Bouleti, Benoît Lattuca, Stéphane Andrieu, Julien Fabre, Reza Rossanaly Vasram, Jean-Claude Dib, Victor Aboyans, Charles Fauvel, François Roubille, Édouard Gerbaud, Claude Boccara, Étienne Puymirat, Solenn Toupin, Éric Vicaut, Patrick Henry, Victor Aboyans, Emeric Albert, Franck Albert, Sean Alvain, Nabil Amri, Stéphane Andrieu, Sabir Attou, Simon Auvray, Sonia Azzakani, Ruben Azencot, Marc Bédossa, Franck Boccara, Claude Boccara, Thomas Bochaton, Eric Bonnefoy‐Cudraz, Guillaume Bonnet, Guillaume Bonnet, Nabil Bouali, Océane Bouchot, Claire Bouleti, Tanissia Boukertouta, Jean-Baptiste Brette, Marjorie Canu, Aurès Chaïb, C. Charbonnel, Anne-Solène Chaussade, Alexandre Coppens, Yves Cottin, Arthur Darmon, Elena De Angelis, Clément Delmas, Laura Delsarte, Antoine Deney, Jean-Claude Dib, Jean‐Guillaume Dillinger, Clémence Docq, Valentin Dupasquier, Meyer Elbaz, Antony El Hadad, Amine El Ouahidi, Nacim Ezzouhairi, Julien Fabre, Damien Fard, Charles Fauvel, Édouard Gerbaud, Martine Gilard, Marc Goralski, Nissim Grinberg, Alain Grentzinger, Marie Hauguel‐Moreau, Patrick Henry, Fabien Huet, Thomas Landemaine, Benoît Lattuca, Léo Lemarchand, Thomas Levasseur, Pascal Lim, Laura Maitre Ballesteros, Nicolas Mansencal, B. De Sainte Marie, D. Rodríguez Martínez, Benoît Mérat, Christophe Meune, Damien Millischer, Thomas Moine, Pascal Nhan, Nathalie Noirclerc, Patrick Ohlmann, Théo Pezel, Fabien Picard, Nicolas Piliero, Thibaut Pommier, Étienne Puymirat, Arthur Ramonatxo, Reza Rossanaly Vasram, François Roubille, Vincent Roule, Guillaume Schurtz, Mathilde Stevenard, David Sulman, Fédérico Swedsky, Victoria Tea, Eugénie Thevenet, Christophe Thuaire, Antonin Trimaille, Christophe Tron, Guillaume Viboud, Dominique Yomi, Cyril Zakine,

Cardiac Arrest and Resuscitation

BackgroundSmoking cigarettes produces carbon monoxide (CO), which can reduce the oxygen-carrying capacity of the blood. We aimed to determine whether elevated expiratory CO levels would be associated with a worse prognosis in smokers presenting with acute cardiac events.MethodsFrom 7 to 22 April 2021, expiratory CO levels were measured in a prospective registry including all consecutive patients admitted for acute cardiac event in 39 centres throughout France. The primary outcome was 1-year all-cause death. Initial in-hospital major adverse cardiac events (MAE; death, resuscitated cardiac arrest and cardiogenic shock) were also analysed. The study was registered at ClinicalTrials.gov (NCT05063097).FindingsAmong 1379 patients (63 ± 15 years, 70% men), 368 (27%) were active smokers. Expiratory CO levels were significantly raised in active smokers compared to non-smokers. A CO level >11 parts per million (ppm) found in 94 (25.5%) smokers was associated with a significant increase in death (14.9% for CO > 11 ppm vs. 2.9% for CO ≤ 11 ppm; p < 0.001). Similar results were found after adjustment for comorbidities (hazard ratio [HR] [95% confidence interval (CI)]): 5.92 [2.43–14.38]) or parameters of in-hospital severity (HR 6.09, 95% CI [2.51–14.80]) and propensity score matching (HR 7.46, 95% CI [1.70–32.8]). CO > 11 ppm was associated with a significant increase in MAE in smokers during initial hospitalisation after adjustment for comorbidities (odds ratio [OR] 15.75, 95% CI [5.56–44.60]) or parameters of in-hospital severity (OR 10.67, 95% CI [4.06–28.04]). In the overall population, CO > 11 ppm but not smoking was associated with an increased rate of all-cause death (HR 4.03, 95% CI [2.33–6.98] and 1.66 [0.96–2.85] respectively).InterpretationElevated CO level is independently associated with a 6-fold increase in 1-year death and 10-fold in-hospital MAE in smokers hospitalized for acute cardiac events.FundingGrant from Fondation Coeur & Recherche.