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Impact of Smoking on Platelet Reactivity and Clinical Outcomes After Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2019; 12:e007982. [DOI: 10.1161/circinterventions.119.007982] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Smoking is a potent risk factor for coronary artery disease; however, prior studies describe increased platelet inhibition with clopidogrel among smokers, and some studies report improved outcomes among smokers, a finding described as the smoker’s paradox. This study assessed the relationship between platelet reactivity and clinical outcomes after percutaneous coronary interventions among current smokers and nonsmokers.
Methods:
ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) was a prospective, multicenter registry of patients treated with coronary drug-eluting stents. Platelet reactivity was assessed by the VerifyNow point-of-care assay; high on-treatment platelet reactivity (HPR) was defined as P2Y12 reaction units >208. A propensity-adjusted multivariable analysis was performed to determine the relationship between current smoking, platelet reactivity, and subsequent adverse events.
Results:
Among 8582 patients, 22.6% were active smokers at the time of their percutaneous coronary intervention procedure. Current smokers were younger and had fewer comorbidities compared with nonsmokers. Current smokers had lower mean P2Y12 reaction units and lower rates of HPR compared with nonsmokers. Current smokers had similar rates of adverse events compared with nonsmokers. HPR was associated with higher rates of adverse events for both smokers and nonsmokers; however, there was evidence of interaction between smoking status and the effect of HPR. Smokers with HPR had significantly higher rates of stent thrombosis. Adverse event rates were highest among current smokers with HPR.
Conclusions:
Current smoking was associated with lower P2Y12 reaction units and lower rates of HPR on average; however, the combination of current smoking and HPR was associated with high rates of stent thrombosis.
Clinical Trial Registration:
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT00638794.
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Sharma SP, Dahal K, Rijal J, Fonarow GC. Meta-Analysis Comparing Outcomes of Smokers Versus Nonsmokers With Acute Coronary Syndrome Underwent Percutaneous Coronary Intervention. Am J Cardiol 2018; 122:973-980. [PMID: 30057236 DOI: 10.1016/j.amjcard.2018.05.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/18/2018] [Accepted: 05/24/2018] [Indexed: 11/28/2022]
Abstract
Several studies have found improved mortality in smokers after acute coronary syndrome (ACS) especially in the thrombolytic era. We aimed to assess the association of smoking status with mortality and cardiovascular outcomes in patients with ACS treated with percutaneous coronary intervention (PCI). We searched PubMed, EMBASE, CINAHL, and Cochrane CENTRAL for randomized controlled trials since inception through February 15, 2018 and used random effects model for analysis. The outcomes analyzed were all-cause mortality, major adverse cardiac events (MACE), myocardial infarction, and target vessel revascularization at 1 month and 1 year. We included 17 randomized and nonrandomized studies with a total of 55,491 patients with 21,989 smokers' and 33,502 nonsmokers. In ACS patients treated with PCI, smokers were found to have lower mortality than nonsmokers at 30-day ([2.3% vs 3.3%; Odds ratio; 0.54; 95% confidence interval: 0.39 to 0.76; p <0.001, I2 = 74%] and 1-year [2.3% vs 3.6%; Odds ratio 0.54 (0.3 to 0.7); p <0.001, I2 = 77%]. Meta-regression showed lower mortality in smokers was associated with younger age, man gender, and lower prevalence of diabetes mellitus. No significant differences were observed in myocardial infarction, MACE, and target-vessel revascularization between smokers and nonsmokers. In conclusion, smoking is associated with lower mortality but not MACE in ACS patients treated with PCI at 1-month and 1-year. This association with mortality was strongly associated with younger age, man gender, prevalence of diabetes mellitus, and extent of coronary artery disease.
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Affiliation(s)
- Sharan P Sharma
- University of New England, LRGHealthcare, Laconia, New Hampshire.
| | - Khagendra Dahal
- Department of Cardiology, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Jharendra Rijal
- Department of Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Gregg C Fonarow
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
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3
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Liu Y, Han T, Gao M, Wang J, Liu F, Zhou S, Chen Y. Clinical characteristics and prognosis of acute myocardial infarction in young smokers and non-smokers (≤ 45 years): a systematic review and meta-analysis. Oncotarget 2017; 8:81195-81203. [PMID: 29113379 PMCID: PMC5655274 DOI: 10.18632/oncotarget.21092] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 09/04/2017] [Indexed: 11/25/2022] Open
Abstract
The effect of smoking on the prognosis of young patients with acute myocardial infarction (AMI) is inconclusive. We enrolled 2188 young AMI patients (≤ 45 years) from the cardiac center of the Chinese PLA General Hospital and Anzhen Hospital and analyzed their clinical characteristics and prognosis. We also searched the PubMed, EMBASE, and Cochrane Central Register of Controlled Trials electronic databases for January 2001 to March 2017 and considered for inclusion in a meta-analysis those clinical trials that compared prognoses of young smokers and non-smokers with AMI. The proportion of males and alcohol users was higher in young AMI smokers than in non-smokers; the proportion of hypertension was slightly lower. There was no difference in medical treatment between smokers and non-smokers. No differences were evident between smokers and non-smokers regarding in-hospital cardiac events and major adverse cardiovascular events on follow-up, including incidence of stroke. For young AMI patients, smoking did not lead to poorer prognosisin comparison with not smoking. This “smoker's paradox” needs to be confirmed by more randomized controlled multicenter prospective clinical trials.
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Affiliation(s)
- Yuqi Liu
- Department of Cardiology, PLA General Hospital, Beijing 100853, China
| | - Tianwen Han
- Department of Cardiology, PLA General Hospital, Beijing 100853, China
| | - Ming Gao
- ICU of The First Phase Beijing Tsinghua Changgeng Hospital, Beijing 100044, China
| | - Jinwen Wang
- Department of Cardiology of Anzhen Hospital, Beijing 100029, China
| | - Fang Liu
- Department of Cardiology of Anzhen Hospital, Beijing 100029, China
| | - Shanshan Zhou
- Department of Cardiology, PLA General Hospital, Beijing 100853, China
| | - Yundai Chen
- Department of Cardiology, PLA General Hospital, Beijing 100853, China
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Wu PJ, Wang HT, Sung PH, Tong MS, Yang CH, Chen CJ, Lin CJ, Hsueh SK, Chung SY, Chung WJ, Hang CL, Wu CJ, Yip HK. No correlation between body mass index and 30-day prognostic outcome in Asians with acute ST-elevation myocardial infarction undergoing primary coronary intervention. Biomed J 2017; 40:169-177. [PMID: 28651739 PMCID: PMC6136285 DOI: 10.1016/j.bj.2016.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 12/18/2016] [Accepted: 12/27/2016] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND This study investigated whether body mass index (BMI) was a risk factor predictive of 30-day prognostic outcome in Asians with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). MATERIAL AND METHODS Data regarding the impact of BMI on the prognostic outcome in Asian populations after acute STEMI is scarce. A number of 925 STEMI patients were divided into three groups according to the BMI: normal weight (<25 kg/m2), overweight (≥25.0 to <30.0 kg/m2) and obese (≥30.0 kg/m2). RESULTS The obese group was significantly younger with significantly higher incidences of smoking and diabetes mellitus. The incidences of multi-vessel disease, final thrombolysis in myocardial infarction (TIMI)-3 flow, advanced Killip score, advance congestive heart failure, 30-day mortality and combined 30-day major adverse clinical outcome (MACO) did not differ among the three groups. Multiple regression analysis showed the age, unsuccessful reperfusion and lower left ventricular ejection fraction were most significant and independent predictor of 30-day mortality. CONCLUSION BMI is not a predictor of 30-day prognostic outcome in Asians with STEMI undergoing primary PCI.
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Affiliation(s)
- Po-Jui Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hui-Ting Wang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pei-Hsun Sung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Meng-Shen Tong
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Hsu Yang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Jen Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Jei Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shu-Kai Hsueh
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Ying Chung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Jung Chung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chi-Ling Hang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Hon-Kan Yip
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Center for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Institute of Shock Wave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan; Department of Nursing, Asia University, Taichung, Taiwan.
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5
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La paradoja del tabaco en el síndrome coronario agudo. El abandono previo del hábito tabáquico como marcador de mejor pronóstico a corto plazo. Rev Clin Esp 2016; 216:301-7. [DOI: 10.1016/j.rce.2016.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 03/02/2016] [Accepted: 03/21/2016] [Indexed: 11/19/2022]
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Bastos-Amador P, Almendro-Delia M, Muñoz-Calero B, Blanco-Ponce E, Recio-Mayoral A, Reina-Toral A, Cruz-Fernandez J, García-Alcántara A, Hidalgo-Urbano R, García-Rubira J. The tobacco paradox in acute coronary syndrome. The prior cessation of smoking as a marker of a better short-term prognosis. Rev Clin Esp 2016. [DOI: 10.1016/j.rceng.2016.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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7
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Santos IS, Goulart AC, Brandão RM, Santos RCDO, Bittencourt MS, Sitnik D, Pereira AC, Pastore CA, Samesima N, Lotufo PA, Bensenor IM. One-year Mortality after an Acute Coronary Event and its Clinical Predictors: The ERICO Study. Arq Bras Cardiol 2015; 105:53-64. [PMID: 25993485 PMCID: PMC4523288 DOI: 10.5935/abc.20150044] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 02/09/2015] [Indexed: 12/29/2022] Open
Abstract
Background Information about post-acute coronary syndrome (ACS) survival have been mostly
short-term findings or based on specialized, cardiology referral centers. Objectives To describe one-year case-fatality rates in the Strategy of Registry of Acute
Coronary Syndrome (ERICO) cohort, and to study baseline characteristics as
predictors. Methods We analyzed data from 964 ERICO participants enrolled from February 2009 to
December 2012. We assessed vital status by telephone contact and official death
certificate searches. The cause of death was determined according to the official
death certificates. We used log-rank tests to compare the probabilities of
survival across subgroups. We built crude and adjusted (for age, sex and ACS
subtype) Cox regression models to study if the ACS subtype or baseline
characteristics were independent predictors of all-cause or cardiovascular
mortality. Results We identified 110 deaths in the cohort (case-fatality rate, 12.0%). Age [Hazard
ratio (HR) = 2.04 per 10 year increase; 95% confidence interval (95%CI) =
1.75–2.38], non-ST elevation myocardial infarction (HR = 3.82 ; 95%CI = 2.21–6.60)
or ST elevation myocardial infarction (HR = 2.59; 95%CI = 1.38–4.89) diagnoses,
and diabetes (HR = 1.78; 95%CI = 1.20‑2.63) were significant risk factors for
all-cause mortality in the adjusted models. We found similar results for
cardiovascular mortality. A previous coronary artery disease diagnosis was also an
independent predictor of all-cause mortality (HR = 1.61; 95%CI = 1.04–2.50), but
not for cardiovascular mortality. Conclusion We found an overall one-year mortality rate of 12.0% in a sample of post-ACS
patients in a community, non-specialized hospital in São Paulo, Brazil. Age, ACS
subtype, and diabetes were independent predictors of poor one‑year survival for
overall and cardiovascular-related causes.
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Affiliation(s)
| | | | | | | | | | - Débora Sitnik
- Hospital Universitário, Universidade de São Paulo, São Paulo, SP, BR
| | | | - Carlos Alberto Pastore
- Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR
| | - Nelson Samesima
- Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR
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8
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Robertson JO, Ebrahimi R, Lansky AJ, Mehran R, Stone GW, Lincoff AM. Impact of cigarette smoking on extent of coronary artery disease and prognosis of patients with non-ST-segment elevation acute coronary syndromes: an analysis from the ACUITY Trial (Acute Catheterization and Urgent Intervention Triage Strategy). JACC Cardiovasc Interv 2014; 7:372-9. [PMID: 24630881 DOI: 10.1016/j.jcin.2013.11.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 11/07/2013] [Accepted: 11/21/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study sought to evaluate the short- and long-term outcomes for smokers with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). BACKGROUND Smoking has been associated with the "paradox" of reduced mortality after acute myocardial infarction (MI). This is thought to be due to favorable baseline characteristics and less diffuse coronary artery disease (CAD) among smokers. METHODS In the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial, 13,819 patients (29.1% smokers) with moderate- to high-risk NSTE-ACS underwent angiography and, if indicated, revascularization. RESULTS Smokers were significantly younger and had fewer comorbidities than nonsmokers. Incidence of death and MI were comparable at 30 days, although smokers had significantly reduced risks of 30-day major bleeding (hazard ratio [HR]: 0.80, 95% confidence interval [CI]: 0.67 to 0.96; p = 0.016) and 1-year mortality (HR: 0.797, 95% CI: 0.65 to 0.97; p = 0.027). After correction for baseline and clinical differences, smoking was no longer predictive of major bleeding (odds ratio: 1.06, 95% CI: 0.86 to 1.32; p = 0.56) and was associated with higher 1-year mortality (HR: 1.37, 95% CI: 1.07 to 1.7; p = 0.013). This pattern of reversed risk after multivariable correction held true for those smokers requiring percutaneous coronary intervention. Core laboratory angiographic analysis showed that smokers and nonsmokers were comparable in terms of the extent of CAD, Thrombolysis In Myocardial Infarction flow, myocardial blush, and the presence of thrombi. CONCLUSIONS In contrast to the paradox previously described in ST-segment elevation MI, our analysis finds smoking to be an independent predictor of higher 1-year mortality in patients presenting with NSTE-ACS, and our angiographic study demonstrates CAD in smokers that is comparable to that in nonsmokers but evident ∼1 decade earlier. (Acute Catheterization and Urgent Intervention Triage Strategy [ACUITY]; NCT00093158).
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Affiliation(s)
- Jason O Robertson
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Ramin Ebrahimi
- University of California Los Angeles and the Greater Los Angeles VA Medical Center, Los Angeles, California
| | | | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, New York; Cardiovascular Research Foundation, New York, New York
| | - Gregg W Stone
- Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York
| | - A Michael Lincoff
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
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9
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Bacaksiz A, Kayrak M, Vatankulu MA, Ayhan SS, Sonmez O, Akilli H, Aribas A, Ari H, Ozdemir K. The Effect of Smoking on Myocardial Performance Index in Middle-Aged Males after First Acute Myocardial Infarction. Echocardiography 2012; 30:155-63. [DOI: 10.1111/echo.12029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Ahmet Bacaksiz
- Department of Cardiology; BezmiÂlem Foundation University; Istanbul; Turkey
| | - Mehmet Kayrak
- Department of Cardiology; Meram School of Medicine; Selcuk University; Konya; Turkey
| | | | - Selim S. Ayhan
- Department of Cardiology; Abant Izzet Baysal University; Bolu; Turkey
| | - Osman Sonmez
- Department of Cardiology; BezmiÂlem Foundation University; Istanbul; Turkey
| | - Hakan Akilli
- Department of Cardiology; Meram School of Medicine; Selcuk University; Konya; Turkey
| | - Alpay Aribas
- Department of Cardiology; Meram School of Medicine; Selcuk University; Konya; Turkey
| | - Hatem Ari
- Department of Cardiology; Meram School of Medicine; Selcuk University; Konya; Turkey
| | - Kurtulus Ozdemir
- Department of Cardiology; Meram School of Medicine; Selcuk University; Konya; Turkey
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10
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Chen KY, Rha SW, Li YJ, Jin Z, Minami Y, Park JY, Poddar KL, Ramasamy S, Wang L, Li GP, Choi CU, Oh DJ, Jeong MH. ‘Smoker's paradox’ in young patients with acute myocardial infarction. Clin Exp Pharmacol Physiol 2012; 39:630-5. [PMID: 22551379 DOI: 10.1111/j.1440-1681.2012.05721.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Seung-Woon Rha
- Cardiovascular Center; Korea University Guro Hospital; Seoul; Korea
| | - Yong-Jian Li
- Cardiology Department; Tianjin Naikai Hospital; Tianjin; China
| | - Zhe Jin
- Cardiology Department; Tianjin Naikai Hospital; Tianjin; China
| | - Yoshiyasu Minami
- Cardiovascular Center; Shonan Kamakura General Hospital; Kamakura; Japan
| | - Ji Young Park
- Cardiovascular Center; Korea University Guro Hospital; Seoul; Korea
| | | | | | - Lin Wang
- Cardiology Department; Tianjin Chest Hospital; Tianjin; China
| | - Guang-Ping Li
- Cardiology Department; The Second Hospital of Tianjin Medical University; Tianjin; China
| | - Cheol-Ung Choi
- Cardiovascular Center; Korea University Guro Hospital; Seoul; Korea
| | - Dong Joo Oh
- Cardiovascular Center; Korea University Guro Hospital; Seoul; Korea
| | - Myung Ho Jeong
- Cardiovascular Center; Chonnam National University Hospital; Gwangju; Korea
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11
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Plasma concentrations of soluble CD40 ligand in smokers with acute myocardial infarction: a pilot study. Heart Vessels 2010; 26:131-7. [PMID: 20978895 PMCID: PMC3053450 DOI: 10.1007/s00380-010-0036-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Accepted: 02/25/2010] [Indexed: 10/26/2022]
Abstract
Coronary artery disease (CAD) is believed to be the single leading cause of death in both men and women in the world. Smoking is the most important risk factor for CAD. Smoking increases platelet aggregation and thrombus formation. CD40 ligand (CD40L) is a transmembrane glycoprotein derived from activated platelets. It participates in thrombus formation during the acute phase of acute myocardial infarction (MI). Elevation of CD40L identifies the patients who are at highest risk for cardiac events and who are likely to benefit from treatment with the glycoprotein IIb/IIIa (GPIIb/IIIa) receptor antagonists. The purpose of this study was to evaluate levels of CD40L in smokers with acute MI. Fifty-seven patients with acute MI were enrolled in this study. Thirty-one smokers were compared with 26 non-smokers. Soluble CD40L level in the plasma was determined by a standard enzyme-linked immunosorbent assay. Circulating levels of CD40L were higher in the smokers' group. Smokers with acute MI may have increased risk for thrombotic complications during acute MI, and optimal antiaggregant therapy should be administered.
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12
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Aygul N, Ozdemir K, Abaci A, Aygul MU, Duzenli MA, Yazici HU, Ozdogru I, Karakaya E. Comparison of traditional risk factors, angiographic findings, and in-hospital mortality between smoking and nonsmoking Turkish men and women with acute myocardial infarction. Clin Cardiol 2010; 33:E49-54. [PMID: 20552593 DOI: 10.1002/clc.20716] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The prevalence of smoking is high in Turkey. However, there are no data available evaluating the differences between smokers and nonsmokers according to their sex in patients with acute myocardial infarction (AMI) in Turkey. HYPOTHESIS The aim of the study was to determine the prevalence of smoking and its relationship to age, localization, and extension of coronary heart disease (CHD), and other risk factors in Turkish men and women with first AMI. METHODS This study included, 1502 patients with first AMI from 3 different cities in Turkey. The baseline characteristics and traditional risk factors for CHD, Coronary angiographic results, and in-hospital outcome were recorded. RESULTS The proportion of male smokers was significantly higher than that of women (68% vs 18%, P < 0.001). Smokers were younger by almost a decade than nonsmokers (P < 0.001). Male nonsmokers were younger than females; however, the mean age of first AMI was similar in male and female smokers. In both genders, prevalence of hypertension and diabetes mellitus was significantly lower in smokers than in nonsmokers (P < 0.001). Smokers had less multivessel disease and less comorbidity as compared to nonsmokers. Although the in-hospital mortality rate was lower in smokers, smoking status was not an independent predictor of mortality. CONCLUSIONS Smoking, by decreasing the age of first AMI in women, offsets the age difference in first AMI between men and women. The mean age of first AMI is lower in Turkey than most European countries due to a high percentage of smoking.
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Affiliation(s)
- Nazif Aygul
- Selçuk University, Selcuklu Faculty of Medicine, Cardiology Department, Konya, Turkey.
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13
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Addad F, Dridi Z, Jemmali M, Mzoughi K, Hassine M, Ghrissi I, Hamdi S, Mahjoub M, Betbout F, Ben Farhat M, Gamra H. ["Smoker's paradox" and reperfusion's strategy in acute myocardial infarction]. Ann Cardiol Angeiol (Paris) 2010; 59:183-189. [PMID: 20709314 DOI: 10.1016/j.ancard.2010.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Accepted: 07/11/2010] [Indexed: 05/29/2023]
Abstract
UNLABELLED Previous studies have shown that smokers with acute myocardial infarction (AMI) treated by thrombolysis have lower mortality rates than nonsmokers, a phenomenon often termed "smoker's paradox". This "smoker's paradox" has been rarely studied in case of primary angioplasty. AIM OF THE STUDY To evaluate the impact of smoking status on the early mortality of patients admitted with AMI with regard to the strategy of reperfusion (intravenous thrombolysis versus primary angioplasty). PATIENTS AND METHODS Study undertaken from the Monsatir registry of ST elevation MI including 688 patients having had either a hospital or a prehospital thrombolysis (n=397) or a primary angioplasty (n=291). Among those patients, 482 (70.1%) were active smokers. RESULTS In the thrombolysis group, the prevalence of hypertension, diabetes and anterior location of MI was significantly less among smokers. In the group primary angioplasty, only diabetes and hypertension were less frequent. The immediate mortality was significantly less among smokers in case of thrombolysis comparatively to non-smokers (5.3 vs 13%; p=0.008). By multivariate analysis, cardiogenic shock (p<0.0001), anterior MI (p=0.03) and active smoking (p=0.03) were independent predictive factors of mortality in case of thrombolysis. A trend toward a lower mortality among smokers was observed in the primary angioplasty group (10 vs 17.6%; p=0.07). CONCLUSION "The smoker's paradox" seems to be observed mainly among patients having had thrombolysis.
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Affiliation(s)
- F Addad
- Unité de recherche cardiothrombose 04-08, service de cardiologie A, CHU Fattouma Bourguiba, 5000 Monastir, Tunisie.
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Albertal M, Cura F, Escudero AG, Thierer J, Trivi M, Padilla LT, Belardi J. Mechanism involved in the paradoxical effects of active smoking following primary angioplasty: a subanalysis of the Protection of Distal Embolization in High-Risk Patients with Acute Myocardial Infarction trial. J Cardiovasc Med (Hagerstown) 2008; 9:810-2. [DOI: 10.2459/jcm.0b013e3282f73519] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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15
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Elosua R, Vega G, Rohlfs I, Aldasoro E, Navarro C, Cabades A, Demissie S, Segura A, Fiol M, Moreno-Iribas C, Echanove I, Tormo MJ, Arteagoitia JM, Sala J, Marrugat J. Smoking and myocardial infarction case-fatality: hospital and population approach. ACTA ACUST UNITED AC 2007; 14:561-7. [PMID: 17667648 DOI: 10.1097/hjr.0b013e32804955b3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Smoking is a risk factor for coronary heart disease, but it has been associated with better short-term prognosis in hospitalized patients with acute myocardial infarction. The aims of this study were to determine the association between smoking and myocardial infarction 28-day case-fatality in hospitalized patients and at the population level; and, whether smokers presenting with fatal myocardial infarction are more likely to die before reaching a hospital. DESIGN AND METHODS Population-based myocardial infarction registry, carried out in 1997-1998 in seven regions of Spain, used standardized methods to find and analyze suspected myocardial infarction patients (10 654 patients; 7796 hospitalized). Four categories of smoking status were defined: never-smokers, former smokers for more than 1 year, former smokers for less than 1 year, and current smokers. RESULTS The main end-point was 28-day case-fatality, found to be 20.1, 17.1, 15.6, and 8.9%, in the four smoking status categories, respectively, for hospitalized patients; and 37.4, 33.0, 24.5, and 23.2%, respectively, at population level. Hospitalized current smokers had lower age, sex, and comorbidity-adjusted 28-day case-fatality than never-smokers (odds ratio=0.71; 95% confidence interval: 0.56-0.90). This association held at population level (odds ratio=0.68; 95% confidence interval: 0.60-0.76), in which former smoking was also associated with lower case-fatality. In fatal cases, recent former smokers presented a lower risk of out-of-hospital death than never-smokers (odds ratio=0.47; 95% confidence interval: 0.29-0.77), whereas current smoking was marginally associated with out-of-hospital death (odds ratio=1.22; 95% confidence interval: 0.99-1.50). CONCLUSIONS Current smoking is associated with lower 28-day case-fatality in hospitalized myocardial infarction patients. This association held at population level. Among fatal cases, smoking is associated with higher and recent former smoking with lower risk of dying out-of-hospital.
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Affiliation(s)
- Roberto Elosua
- Lipids and Cardiovascular Epidemiology Unit, IMIM, Barcelona, Spain
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Robertson JO, Lincoff AM, Wolski K, Topol EJ. Planned versus provisional use of glycoprotein IIb/IIIa inhibitors in smokers undergoing percutaneous coronary intervention. Am J Cardiol 2006; 97:1679-84. [PMID: 16765113 DOI: 10.1016/j.amjcard.2005.12.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2005] [Revised: 12/21/2005] [Accepted: 12/21/2005] [Indexed: 11/23/2022]
Abstract
Postmortem and angiographic studies have demonstrated that thrombosis is the primary cause of coronary artery occlusion in smokers. Further, smokers have high levels of fibrinogen, increased platelet aggregation, and more platelet-dependent thrombin generation than do nonsmokers, suggesting that glycoprotein (GP) IIb/IIIa inhibitor use during percutaneous coronary intervention (PCI) may be especially useful among smokers. We evaluated a subpopulation of active smokers in the REPLACE-2 trial to assess the effect of treating smokers with bivalirudin and provisional GP IIb/IIIa blockade compared with heparin and planned GP IIb/IIIa blockade. The REPLACE-2 trial enrolled 1,558 smokers and 4,305 nonsmokers. Smokers who were treated with bivalirudin had an absolute 3.2% increase in the composite end point of death and myocardial infarction at 48 hours compared with smokers who were treated with heparin and GP IIb/IIIa inhibitors (7.7% vs 4.5%, p=0.008, interaction p=0.016). This difference was ameliorated when GP IIb/IIIa inhibitors were used consistently in a previous trial that compared bivalirudin with heparin during PCI (4.6% vs 6.7%, p=0.322). In conclusion, these results suggest that smokers may derive particular benefit with GP IIb/IIIa inhibitors for decreasing myocardial infarction and death after PCI. These findings require further validation from other large, randomized trials.
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Affiliation(s)
- Jason O Robertson
- The Department of Cardiovascular Medicine, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Ovbiagele B, Weir CJ, Saver JL, Muir KW, Lees KR. Effect of smoking status on outcome after acute ischemic stroke. Cerebrovasc Dis 2006; 21:260-5. [PMID: 16446540 DOI: 10.1159/000091224] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2005] [Accepted: 10/20/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The status of smoking as a risk factor for the occurrence of stroke is well established. However, there is a paucity of data on the relationship between smoking status and acute stroke outcomes. We evaluated the role of recent smoking as a prognostic factor following acute ischemic stroke. METHODS We analyzed data from patients enrolled in the Intravenous Magnesium Efficacy in Stroke (IMAGES) trial. Outcome measures studied included change in IMAGES stroke score, poor functional outcomes at day 30 and 90 (defined as Rankin Scale >1 and Barthel Index <95), and survival over the first 3 months after stroke. The independent effect of smoking status (subjects who had smoked in the past year) on outcome was evaluated by logistic regression analysis and Cox's proportional hazards model, adjusting for variables known to predict outcome after ischemic stroke. RESULTS There were 2,386 subjects in the IMAGES efficacy dataset, including 615 recent or current smokers and 1,771 nonsmokers, among whom smokers were younger (p < 0.0001). After adjusting for covariates, smokers had increased odds of poor 90-day functional outcome independently of other statistically significant predictor variables, as assessed by Rankin Scale (odds ratio 1.38; 95% confidence interval 1.09-1.75) and Barthel Index (odds ratio 1.42; 95% confidence interval 1.13-1.79) at day 90. Smoking status did not affect survival at day 90. CONCLUSIONS Current or recent smokers experience poorer functional outcomes than nonsmokers 3 months after acute ischemic stroke.
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Affiliation(s)
- Bruce Ovbiagele
- Stroke Center and Department of Neurology, UCLA School of Medicine, Los Angeles, CA 90095, USA.
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Weisz G, Cox DA, Garcia E, Tcheng JE, Griffin JJ, Guagliumi G, Stuckey TD, Rutherford BD, Mehran R, Aymong E, Lansky A, Grines CL, Stone GW. Impact of smoking status on outcomes of primary coronary intervention for acute myocardial infarction--the smoker's paradox revisited. Am Heart J 2005; 150:358-64. [PMID: 16086943 DOI: 10.1016/j.ahj.2004.01.032] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2003] [Accepted: 01/30/2004] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We sought to determine the relationship between cigarette smoking and outcomes after mechanical reperfusion therapy in acute myocardial infarction (AMI). BACKGROUND Prior studies have found that smokers with AMI have lower mortality rates and a more favorable response to fibrinolytic therapy than nonsmokers. The impact of cigarette smoking in patients undergoing primary percutaneous coronary intervention has not been examined. METHODS In the CADILLAC trial, 2082 patients with AMI were randomized to percutaneous transluminal coronary angioplasty +/- abciximab versus stenting +/- abciximab. Data on smoking status were prospectively collected and follow-up continued for 1 year. RESULTS At the time of presentation, 638 (31%) patients had never smoked, 546 (26%) were former smokers, and 898 (45%) were currently smoking. In comparison to nonsmokers, current smokers were younger, more often men, and less frequently had diabetes, hypertension, prior AMI, and triple-vessel coronary disease. Procedural success rates were unrelated to smoking status. Mortality was lowest in current smokers, intermediate in former smokers, and highest in nonsmokers at 30 days (1.3% vs 1.7% vs 3.5%, respectively, P = .02) and 1 year (2.9% vs 3.7% vs 6.6%, P = .0008). After multivariate correction for differences in baseline variables, however, current smoking status was no longer protective from late mortality (hazard ratio 0.96, 95% CI 0.52-1.76, P = .89). CONCLUSIONS The "smoker's paradox" extends to patients undergoing primary PCI for AMI, with increased survival seen in current smokers, an effect entirely explained by differences in baseline risk and not smoking status per se. The deleterious effects of smoking are expressed in the occurrence of AMI nearly a decade earlier than in nonsmokers, with similar age-adjusted risk, mandating intensive primary and secondary cigarette-cessation efforts.
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Affiliation(s)
- Giora Weisz
- Cardiovascular Research Foundation and Center for Interventional Therapy, New York, NY, USA
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Ishihara M, Inoue I, Kawagoe T, Shimatani Y, Kurisu S, Nishioka K, Kouno Y, Umemura T, Nakamura S. Fifteen-year trend in the treatment and outcome of acute myocardial infarction in Japan. Circ J 2002; 66:178-81. [PMID: 11999644 DOI: 10.1253/circj.66.178] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To assess the changes in treatment and outcome of acute myocardial infarction (AMI) over a 15-year period, the medical records of 1,437 patients with AMI who underwent emergency coronary angiography within 24h of the onset of chest pain at Hiroshima City Hospital from 1985 to 1999 were reviewed. The patients were divided into 3 groups in chronological order: group 1 (1985-89, n=439), group 2 (1990-94, n=453) and group 3 (1995-99, n=545). Conventional balloon angioplasty and thrombolysis were frequently performed in group 1 (56% and 29%, respectively) and group 2 (71% and 13%, respectively), whereas coronary stenting and conventional balloon angioplasty were more often performed in group 3 (57% and 23%, respectively). The achievement of TIMI grade 3 flow improved in the chronological order (62%, 80% and 85%, respectively; p<0.001). The incidence of reinfarction was lower in group 3 (4.2%) than groups 1 and 2 (8.0% and 7.5%, respectively; p=0.007), and in-hospital mortality decreased from group 1 to group 3 (11.8%, 8.2% and 5.5%, respectively; p=0.002). Stenting is now the most frequently chosen treatment for AMI and sustained TIMI grade 3 flow is obtained in most of the cases, with the result that mortality has reduced by 50% in the past decade.
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Landmark K, Abdelnoor M. Current smokers develop more posterior myocardial infarctions probably due to increased tendency to thrombosis. SCAND CARDIOVASC J 2000; 34:73-8. [PMID: 10816064 DOI: 10.1080/14017430050142431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This investigation was carried out to determine whether smokers developed smaller infarcts as assessed by peak enzyme levels and also to what extent smoking could modify infarct localization. The study included 753 patients, of whom 351 had no history of previous coronary heart disease (CHD) (angina pectoris and/or myocardial infarction (MI)). The investigation was designed as an exposed (smoking) versus non-exposed (non-smoking) cohort study. Outcome was infarct size, posterior versus non-posterior MI and non-Q-wave versus Q-wave infarcts. In the total cohort of patients, 312 (41%) were smokers, the corresponding number in the restricted cohort of patients without a previous CHD (CHD-0-pts) was 169 (48%). Smokers were younger than non-smokers, and more of them were males. It was found that infarct size was similar in smokers and in non-smokers (crude and adjusted effects). Crude effects showed that smokers developed significantly more posterior infarcts than non-smokers; odds ratio (OR) for developing a posterior MI was 1.95 (2p < 0.001) (all patients) and 2.34 (2P < 0.001) (CHD-0-pts), respectively. After adjusting for confounders (logistic regression model), OR in the two groups was 1.24 (2p = 0.256) and 1.95 (2p = 0.01), respectively. The study shows that current smokers were younger, and indicates that in those without a previous CHD, significantly more of them developed a posterior MI.
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Affiliation(s)
- K Landmark
- Department of Pharmacotherapeutics, Research Forum, Ullevål University Hospital, Oslo, Norway.
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Kennon S, Barakat K, Suliman A, MacCallum PK, Ranjadayalan K, Wilkinson P, Timmis AD. Influence of previous aspirin treatment and smoking on the electrocardiographic manifestations of injury in acute myocardial infarction. Heart 2000; 84:41-5. [PMID: 10862586 PMCID: PMC1729417 DOI: 10.1136/heart.84.1.41] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To examine demographic and clinical characteristics of patients with acute myocardial infarction in order to identify factors affecting the electrocardiographic evolution of injury. METHODS Prospective cohort study of 1399 consecutive patients with a first myocardial infarction. Baseline clinical data associated with ST elevation and Q wave development were identified and 12 month survival was estimated. RESULTS Smoking had complex effects on the evolution of injury, increasing the odds of ST elevation (odds ratio (OR) 1.61; 95% confidence interval (CI) 1.08 to 2.36), but reducing the odds of Q wave development (OR 0.69, 95% CI 0.49 to 0.96). The effects of previous aspirin treatment were more consistent with reductions in the odds of ST elevation (OR 0.57, 95% CI 0.35 to 0.94) and Q wave development (OR 0.53, 95% CI 0.34 to 0. 84). ST elevation and Q wave development were both associated with an adverse prognosis, with estimated 12 month survival rates of 80. 6% (95% CI 78.2% to 83.1%) and 80.0% (95% CI 77.5% to 82.5%), respectively, compared with 86.5% (95% CI 81.2% to 91.9%) and 89.9% (95% CI 86.2% to 93.7%) for patients without these ECG changes. CONCLUSIONS The thrombogenicity of the blood may be a major determinant of infarct severity. Smoking increases thrombogenicity and the likelihood of ST elevation, but because coronary occlusion is relatively more thrombotic in smokers, responses to both endogenous and exogenous thrombolysis are better, reducing the risk of Q wave development. Previous aspirin treatment reduces thrombogenicity, protecting against ST elevation and Q wave development.
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Affiliation(s)
- S Kennon
- Department of Cardiology, Newham Healthcare Trust, London E13, UK.
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