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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El tabaquismo es la primera causa de enfermedad&#44; invalidez y muerte evitable<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">1-4</span></a>&#46; El abandono del tabaco tiene potencialmente m&#225;s capacidad de aumentar la esperanza de vida que cualquier otra medida de salud p&#250;blica&#46; La asociaci&#243;n del tabaco con los eventos cardiovasculares es dosis-dependiente y aumenta si coexisten otros factores de riesgo<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; Por otro lado&#44; el abandono del tabaquismo conlleva una disminuci&#243;n del riesgo asociado al mismo<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">7-10</span></a>&#46; Sin embargo&#44; los pacientes fumadores que presentan un s&#237;ndrome coronario agudo &#40;SCA&#41; presentan un mejor pron&#243;stico a corto plazo que aquellos que no son fumadores<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">11-16</span></a>&#44; lo que se ha descrito como <span class="elsevierStyleItalic">la paradoja del tabaco</span><a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">17</span></a>&#46; Seg&#250;n esta teor&#237;a&#44; aunque un individuo fumador tiene m&#225;s riesgo de presenta un evento coronario&#44; las posibilidades de sobrevivir en el momento agudo son mayores que en los no fumadores<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">18&#44;19</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">En este estudio se describe la presencia de la paradoja del tabaco en nuestro medio y se intenta explicar mediante otros factores pron&#243;sticos&#46; Adem&#225;s&#44; intentamos clarificar la influencia de la condici&#243;n de exfumador en el curso hospitalario tras presentar un evento coronario&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dise&#241;o del estudio</span><p id="par0015" class="elsevierStylePara elsevierViewall">El registro de SCA de la plataforma ARIAM-Andaluc&#237;a es un estudio observacional&#44; prospectivo y multic&#233;ntrico de los pacientes ingresados en las Unidades de Cuidados Intensivos &#40;UCI&#41; o Unidades Coronarias de hospitales de Andaluc&#237;a<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">20</span></a>&#46; Los datos fueron recogidos por los m&#233;dicos en cada centro&#44; mediante un programa inform&#225;tico v&#237;a web&#46; El software posee una serie de herramientas&#44; denominadas CoreTools&#44; que dotan al registro de unos estrictos controles de calidad de la informaci&#243;n introducida&#44; que aplican rangos a todas las variables&#44; dependencias entre las mismas y un conjunto m&#237;nimo de datos registrados&#46; Este estudio cumple con la declaraci&#243;n de Helsinki y la protecci&#243;n de los derechos de los pacientes<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">21</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Analizamos un periodo de 11 a&#241;os&#44; entre enero de 2001 y enero del 2012&#44; con un n&#250;mero total de 42&#46;827 pacientes pertenecientes a 49 hospitales &#40;el listado completo de centros e investigadores se ha publicado previamente&#41;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">20</span></a>&#46; Se recogieron variables epidemiol&#243;gicas y cl&#237;nicas al ingreso&#44; y se realiz&#243; un seguimiento de los pacientes desde su ingreso hasta el alta hospitalaria&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Criterios de inclusi&#243;n</span><p id="par0025" class="elsevierStylePara elsevierViewall">El &#250;nico criterio de inclusi&#243;n consist&#237;a en ser diagnosticado de SCA&#44; tanto con elevaci&#243;n como sin elevaci&#243;n del ST&#44; y requerir ingreso en la UCI&#46; El diagn&#243;stico se realiz&#243; sobre la base de los criterios universales de infarto de miocardio<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">22&#44;23</span></a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Variables estudiadas</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se incluyeron al ingreso&#58; <span class="elsevierStyleItalic">1&#41;</span> variables demogr&#225;ficas como edad y sexo&#59; <span class="elsevierStyleItalic">2&#41;</span> presencia de factores de riesgo cardiovascular&#58; tabaquismo &#40;distinguiendo entre h&#225;bito activo o extabaquismo&#41;&#44; diabetes mellitus&#44; hipertensi&#243;n&#44; dislipidemia&#44; obesidad&#44; historia familiar de cardiopat&#237;a isqu&#233;mica&#59; <span class="elsevierStyleItalic">3&#41;</span> antecedentes m&#233;dicos de inter&#233;s&#58; historia previa de angina&#44; infarto agudo de miocardio&#44; lesiones coronarias conocidas&#44; insuficiencia cardiaca&#44; accidente cerebrovascular&#44; arritmias&#44; enfermedad vascular perif&#233;rica&#44; broncopat&#237;a cr&#243;nica&#44; e insuficiencia renal&#44; y <span class="elsevierStyleItalic">4&#41;</span> presentaci&#243;n del SCA en forma de elevaci&#243;n del ST o en su ausencia&#44; localizaci&#243;n anterior del infarto o presencia de Killip &#8805; 2 al ingreso&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Durante el curso hospitalario se recogieron los siguientes eventos&#58; reinfarto&#44; bloqueo auriculoventricular o asistolia&#44; taquicardia ventricular&#44; fibrilaci&#243;n ventricular&#44; necesidad de ventilaci&#243;n mec&#225;nica&#44; shock&#44; accidente cerebrovascular y mortalidad tanto durante la estancia en la UCI como hospitalaria&#46; La variable principal de valoraci&#243;n fue la mortalidad hospitalaria&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Los pacientes se clasificaron en 3 grupos&#58; fumadores activos&#44; exfumadores y no fumadores&#46; Se defini&#243; como exfumador a aquel paciente que hab&#237;a abandonado el h&#225;bito tab&#225;quico al menos 3 meses antes de su ingreso&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">An&#225;lisis estad&#237;stico</span><p id="par0045" class="elsevierStylePara elsevierViewall">El an&#225;lisis estad&#237;stico se realiz&#243; con el paquete inform&#225;tico Stata 13&#46;1 &#40;Statacorp&#44; Texas&#44; EE&#46; UU&#46;&#44; 2013&#41;&#46; Las variables categ&#243;ricas se expresan como n&#250;meros absolutos y porcentajes&#44; y las variables continuas como media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desviaci&#243;n est&#225;ndar&#46; Las diferencias en las caracter&#237;sticas demogr&#225;ficas y cl&#237;nicas&#44; y los eventos intrahospitalarios entre los 3 grupos &#40;fumadores&#44; no fumadores y exfumadores&#41; se evaluaron con el test de la chi al cuadrado para variables categ&#243;ricas y el test de ANOVA para las variables continuas&#44; estableciendo como nivel de significaci&#243;n estad&#237;stica un valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 bilateral&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Se analiz&#243; la influencia del h&#225;bito tab&#225;quico o de la condici&#243;n exfumador en la mortalidad mediante 2 an&#225;lisis multivariados&#46; En primer lugar&#44; se realiz&#243; un c&#225;lculo de probabilidad inversa ponderada aumentada &#40;augmented inverse probability weights &#91;AIPW&#93;&#41;&#44; con un modelo log&#237;stico de medias ponderadas&#46; El AIPW es un m&#233;todo que combina el ajuste mediante regresi&#243;n y el ajuste de medias ponderado inverso&#46; Para confirmar los resultados&#44; se repiti&#243; la estimaci&#243;n del efecto mediante un an&#225;lisis de propensi&#243;n &#40;propensity matching score&#41;&#44; igualmente con un modelo log&#237;stico&#46; En el an&#225;lisis de propensi&#243;n con Stata cada paciente se compara con otro lo m&#225;s similar posible en cuanto a las variables independientes&#44; con la &#250;nica diferencia del &#171;tratamiento&#187; &#40;fumador o exfumador&#41;<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">24-26</span></a>&#46; Ambos an&#225;lisis se realizaron de forma independiente para cada una de las condiciones&#44; fumador y exfumador&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">En ambos an&#225;lisis se presenta el efecto medio estimado en la poblaci&#243;n&#44; expresado en unidades porcentuales&#44; como un coeficiente que expresa la reducci&#243;n o aumento de la mortalidad&#46; Como variables independientes para ponderar el efecto de los &#171;tratamientos&#187; &#40;fumador o exfumador&#41; sobre la mortalidad&#44; se incluyeron las caracter&#237;sticas cl&#237;nicas cuya distribuci&#243;n fue significativamente diferente entre los grupos de fumadores&#44; exfumadores y no fumadores&#58; edad&#44; sexo&#44; ST elevado&#44; diabetes&#44; dislipidemia&#44; hipertensi&#243;n arterial&#44; historia familiar&#44; angina previa&#44; infarto previo&#44; historia de insuficiencia cardiaca&#44; ictus&#44; insuficiencia renal&#44; vasculopat&#237;a&#44; fibrilaci&#243;n auricular previas&#44; enfermedad pulmonar obstructiva cr&#243;nica y Killip<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>2 al ingreso &#40;<a class="elsevierStyleCrossRef" href="#sec0065">anexo 1</a>&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><p id="par0060" class="elsevierStylePara elsevierViewall">De los 42&#46;827 pacientes incluidos&#44; 14&#46;285 &#40;33&#44;3&#37;&#41; eran fumadores activos&#44; 9&#46;155 &#40;21&#44;4&#37;&#41; exfumadores y 19&#46;387 &#40;45&#44;4&#37;&#41; no fumadores&#46; Los pacientes con SCA y ST elevado fueron 25&#46;633 &#40;59&#44;9&#37;&#41;&#44; sin ST elevado 16&#46;851 &#40;39&#44;3&#37;&#41;&#44; y sin definir 343 &#40;0&#44;8&#37;&#41;&#46;</p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Caracter&#237;sticas basales</span><p id="par0065" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas basales de los pacientes incluidos en el estudio se detallan en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; En comparaci&#243;n con los no fumadores&#44; los pacientes fumadores eran m&#225;s j&#243;venes y&#44; en mayor proporci&#243;n&#44; varones&#46; Adem&#225;s&#44; presentaban menos comorbilidades&#44; y ten&#237;an menos antecedentes personales de cardiopat&#237;a isqu&#233;mica&#44; insuficiencia cardiaca&#44; arritmias e insuficiencia renal&#46; Ten&#237;an&#44; en cambio&#44; m&#225;s antecedentes familiares de cardiopat&#237;a isqu&#233;mica y m&#225;s enfermedad pulmonar obstructiva cr&#243;nica&#46; Entre los fumadores la forma de presentaci&#243;n m&#225;s frecuente fue la elevaci&#243;n del ST y con menor frecuencia presentaban un Killip<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>2&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Por otra parte&#44; en comparaci&#243;n con los no fumadores&#44; el grupo de exfumadores era 2 a&#241;os m&#225;s joven y mayoritariamente varones&#46; Presentaban menos diabetes&#44; hipertensi&#243;n o arritmias previas&#44; pero m&#225;s dislipidemia&#44; infarto o angina previa&#44; vasculopat&#237;a perif&#233;rica&#44; insuficiencia renal&#44; broncopat&#237;a cr&#243;nica e historia familiar de cardiopat&#237;a isqu&#233;mica&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Eventos hospitalarios</span><p id="par0075" class="elsevierStylePara elsevierViewall">En el an&#225;lisis no ajustado&#44; la mortalidad en la UCI y hospitalaria fue significativamente mayor en el grupo de no fumadores&#44; seguida de los exfumadores&#44; apreci&#225;ndose una menor tasa de mortalidad en los fumadores &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; Tanto los fumadores como los exfumadores presentaron menos frecuentemente shock cardiog&#233;nico&#44; bloqueo aur&#237;culo-ventricular o necesidad de ventilaci&#243;n mec&#225;nica&#46; El grupo fumador present&#243; con mayor frecuencia fibrilaci&#243;n ventricular&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">El an&#225;lisis del efecto del tabaquismo previo &#40;exfumador&#41; sobre la mortalidad&#44; ajustado a las otras variables&#44; mostr&#243; una diferencia no significativa con respecto a los fumadores&#44; tanto con el an&#225;lisis de probabilidad inversa como con el de propensi&#243;n&#44; con una diferencia de mortalidad en la poblaci&#243;n de &#8211;0&#44;3 y<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>0&#44;4&#37;&#44; respectivamente&#46; En cambio&#44; la cualidad de exfumador supuso una reducci&#243;n significativa de la mortalidad en ambos test&#44; de 2&#44;2&#37; en el an&#225;lisis de probabilidad inversa &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y del 2&#44;1&#37; en el an&#225;lisis de propensi&#243;n &#40;p 0&#44;005&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discusi&#243;n</span><p id="par0085" class="elsevierStylePara elsevierViewall">Numerosos estudios han demostrado la asociaci&#243;n entre tabaquismo y morbilidad cardiovascular&#44; incluyendo el aumento de riesgo de un evento coronario agudo y muerte s&#250;bita cardiaca<a class="elsevierStyleCrossRefs" href="#bib0400"><span class="elsevierStyleSup">27-29</span></a>&#46; Adem&#225;s&#44; el cese del h&#225;bito tab&#225;quico se ha asociado a una disminuci&#243;n significativa de la mortalidad por todas las causas en pacientes con cardiopat&#237;a isqu&#233;mica<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">10</span></a>&#46; Sin embargo&#44; en pacientes con SCA&#44; diversos trabajos han observado que los fumadores tienen un mejor pron&#243;stico que los no fumadores&#46; Para aclarar esta paradoja se han propuesto varias explicaciones&#44; como una menor edad&#44; menor carga de comorbilidades asociadas y una menor extensi&#243;n de las lesiones coronarias en los paciente fumadores<a class="elsevierStyleCrossRefs" href="#bib0415"><span class="elsevierStyleSup">30&#44;31</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">La edad es el factor pron&#243;stico m&#225;s importante a corto plazo en el SCA<a class="elsevierStyleCrossRefs" href="#bib0425"><span class="elsevierStyleSup">32-35</span></a>&#46; No obstante&#44; en un estudio en el que se evalu&#243; la paradoja del tabaco entre paciente j&#243;venes con SCA&#44; aquellos que eran fumadores tuvieron una mortalidad hospitalaria y a los 8 meses superior al del grupo de no fumadores<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">36</span></a>&#46; Esto difiere de otros trabajos en los que tras ajustar mediante an&#225;lisis multivariado entre ambos grupos seg&#250;n la edad&#44; este supuesto factor pron&#243;stico observado entre los fumadores desaparec&#237;a por completo<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">12-15</span></a>&#46; Estas discrepancias entre estudios pueden ser debidas a diferencias metodol&#243;gicas&#44; tales como la selecci&#243;n de pacientes&#44; el tama&#241;o muestral o las variables incluidas en el an&#225;lisis multivariado&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">En nuestro registro tambi&#233;n observamos una menor edad entre el grupo de pacientes fumadores&#46; Esta diferencia de edad podr&#237;a justificar parcialmente la menor tasa de mortalidad en dicho grupo&#44; ya que al corregir las caracter&#237;sticas basales de los grupos por otros factores relacionados con el pron&#243;stico&#44; desaparec&#237;a el efecto protector del tabaquismo&#46; Sin embargo&#44; en un an&#225;lisis mediante regresi&#243;n log&#237;stica incluyendo m&#250;ltiples covariables previamente publicado por el Grupo ARIAM&#44; el tabaquismo previo segu&#237;a siendo &#171;protector&#187; a corto plazo<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">37</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Barbash et al&#46; estudiaron a 2&#46;400 pacientes reclutados para el subestudio angiogr&#225;fico del GUSTO-I y demostraron que los fumadores presentaban menos frecuentemente afectaci&#243;n multivaso&#44; mientras que ten&#237;an m&#225;s infartos cuya arteria responsable era la coronaria derecha que los no fumadores<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">20</span></a>&#46; En consonancia&#44; los datos de otros estudios angiogr&#225;ficos y epidemiol&#243;gicos sugieren que el infarto agudo de miocardio en fumadores ocurre en un periodo relativamente temprano del proceso de ateroesclerosis coronaria&#46; Adem&#225;s&#44; el estado de hipercoagulabilidad que asocian los fumadores activos&#44; debido a un aumento de hematocrito&#44; fibrin&#243;geno y trombina&#44; y una mayor activaci&#243;n plaquetaria&#44; se ha propuesto para explicar las diferencias pron&#243;sticas en los fumadores<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">12&#44;31</span></a>&#46; La evidencia acumulada apoya que el infarto de miocardio en fumadores ocurre sobre lesiones menos graves que en no fumadores&#44; con un mecanismo trombog&#233;nico predominante<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">31</span></a>&#46; Esto podr&#237;a explicar la mejor respuesta al tratamiento trombol&#237;tico que tambi&#233;n se ha descrito en trabajos previos<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">14&#44;19&#44;31&#44;38</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Recientemente se ha investigado la interacci&#243;n entre clopidogrel y tabaco&#46; El tabaquismo ha demostrado inducir el citocromo P4501A2&#44; causando una mejora en la respuesta al clopidogrel en los fumadores<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">39</span></a>&#46; El estudio CHARISMA &#40;The Clopidogrel for High Atherotrombotic Risk and Ischaemic Stabilization&#44; Management and Avoidance&#41; compar&#243; clopidogrel 75<span class="elsevierStyleHsp" style=""></span>mg al d&#237;a versus placebo en pacientes con perfil de alto riesgo&#44; mostrando una reducci&#243;n significativa de la mortalidad en fumadores&#44; sin alcanzar dicho efecto en no fumadores<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">40</span></a>&#46; Adem&#225;s&#44; el ensayo CLARITY-TIMI 28 &#40;Clopidogrel as Adjunctive Reperfusion Therapy-Thrombolysis in Myocardial Infarction 28&#41; compar&#243; el efecto de clopidogrel con variables angiogr&#225;ficas y cl&#237;nicas en pacientes con SCA y elevaci&#243;n de ST&#44; mostrando que el antiagregante era significativamente m&#225;s efectivo en reducir la tasa de muerte cardiovascular&#44; infarto de miocardio o revascularizaci&#243;n urgente entre los pacientes fumadores<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">41</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Tambi&#233;n se ha descrito un pico de marcadores m&#225;s precoz entre los pacientes fumadores tras presentar un evento coronario agudo&#44; lo que se podr&#237;a relacionar con una menor afectaci&#243;n en la microcirculaci&#243;n coronaria<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">42</span></a>&#46; Esta teor&#237;a tambi&#233;n se podr&#237;a apoyar en el hecho de que en los pacientes con SCA y elevaci&#243;n de ST sin antecedente de tabaquismo se ha objetivado una menor resoluci&#243;n del segmento ST tras la reperfusi&#243;n<a class="elsevierStyleCrossRefs" href="#bib0480"><span class="elsevierStyleSup">43&#44;44</span></a>&#46; Heeschen et al&#46; describieron en un modelo animal con ratones un mayor desarrollo de circulaci&#243;n colateral tras la administraci&#243;n de nicotina<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">45</span></a>&#46; En el mismo sentido&#44; Ruixing et al&#46; evidenciaron la capacidad de la administraci&#243;n intramuscular de nicotina para promover angiog&#233;nesis intramioc&#225;rdica<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">46</span></a>&#46; Por lo tanto&#44; el tabaquismo podr&#237;a aumentar la circulaci&#243;n colateral y prevenir el da&#241;o de la microcirculaci&#243;n despu&#233;s de la terapia de reperfusi&#243;n y esto podr&#237;a explicar por qu&#233; hay un menor n&#250;mero de pacientes con insuficiencia cardiaca en el grupo fumador durante el seguimiento&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Al igual que nuestro trabajo&#44; varios estudios han constatado que el efecto protector del tabaquismo sobre el SCA se explica por otras variables pron&#243;sticas<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">13&#44;15&#44;47</span></a>&#46; En el presente estudio aplicamos una metodolog&#237;a potente y novedosa de an&#225;lisis multivariado&#44; con un estudio de propensi&#243;n en el que se incluy&#243; a todos los pacientes en la estimaci&#243;n del efecto del tabaquismo sobre la mortalidad&#46; Esto demostr&#243; que las covariables s&#237; explican esta aparente paradoja en el caso de los fumadores activos&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Otra conclusi&#243;n que podemos extraer de nuestro trabajo es que el pron&#243;stico de un paciente con SCA es mejor entre aquellos que han abandonado el h&#225;bito tab&#225;quico&#44; de manera similar a lo observado en otros estudios previos<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">10&#44;48</span></a>&#46; Sin embargo&#44; se desconoce las bases fisiopatol&#243;gicas de este efecto beneficioso<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">49</span></a>&#46; Se ha postulado que el abandono previo del tabaco se asocia a una disminuci&#243;n del tama&#241;o de las plaquetas<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">49</span></a> y a una elevaci&#243;n de los niveles de adiponectina<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">50</span></a>&#44; que podr&#237;an condicionar una mejor evoluci&#243;n de un SCA posterior al abandono del tabaco&#46; Numerosos trabajos han comunicado el efecto beneficioso de dejar de fumar entre la poblaci&#243;n general&#44; as&#237; como en pacientes con antecedentes de cardiopat&#237;a isqu&#233;mica<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">10&#44;51&#44;52</span></a>&#46; Por otra parte&#44; van Berkel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">53</span></a> revisaron los datos publicados sobre el impacto del cese del tabaquismo y encontraron que el riesgo relativo de mortalidad entre exfumadores y fumadores activos variaba entre 0&#44;13 y 0&#44;72&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">En nuestro estudio&#44; tras incluir en el an&#225;lisis multivariado un importante n&#250;mero de variables que diferencian a los fumadores de los no fumadores ingresados por un SCA&#44; el tabaquismo no tuvo efecto protector&#46; En contraste&#44; el abandono previo del tabaco s&#237; que tuvo una influencia significativa&#44; con una reducci&#243;n de mortalidad en la poblaci&#243;n analizada de m&#225;s del 1&#44;5&#37; en t&#233;rminos absolutos&#46; Por todo ello&#44; como se&#241;alan Andrikopoulos et al&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">13</span></a> el t&#233;rmino paradoja del tabaco deber&#237;a evitarse&#44; puesto que no existe una paradoja real y su uso podr&#237;a inducir al error en la poblaci&#243;n general de un supuesto beneficio del tabaco en el contexto del SCA&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Este estudio tiene limitaciones&#46; Si bien el registro ARIAM est&#225; dise&#241;ado para incluir todos los pacientes ingresados en una UCI&#44; la introducci&#243;n de cada caso es manual&#44; por lo que depende de la voluntariedad de los investigadores&#46; Esto&#44; al igual que el requisito de ser ingresado en una UCI&#44; puede introducir sesgos de selecci&#243;n de pacientes&#46; Nuestro estudio tiene las limitaciones de todos los registros observacionales&#46; La metodolog&#237;a estad&#237;stica aplicada es una versi&#243;n del an&#225;lisis multivariado y de propensi&#243;n de gran potencia&#44; que aprovecha la informaci&#243;n de todos los pacientes para aproximar el resultado al de un modelo experimental&#44; pero se basa en estimaciones matem&#225;ticas a partir de las variables incluidas&#46; No podemos asegurar que haya otras variables no incluidas que pudieran hacer variar significativamente los resultados&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">En resumen&#44; la paradoja del tabaco en pacientes que ingresan por SCA es un hallazgo que puede quedar explicado al ajustar las caracter&#237;sticas basales por otros factores pron&#243;sticos&#46; El abandono previo del h&#225;bito tab&#225;quico se asocia a un mejor pron&#243;stico cuando se ingresa por un SCA&#46; Por tanto&#44; debemos recalcar la importancia de evitar este h&#225;bito nocivo en la poblaci&#243;n general&#44; as&#237; como procurar el abandono del mismo entre los fumadores activos&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicto de intereses</span><p id="par0140" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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    "fechaRecibido" => "2015-10-19"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La paradoja del tabaco es un fen&#243;meno insuficientemente explicado en estudios previos&#46; Este estudio analiza el papel pron&#243;stico del tabaquismo previo o activo en pacientes con s&#237;ndrome coronario agudo&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Obtuvimos los datos del registro ARIAM&#44; entre 2001 y 2012&#46; Se incluy&#243; a 42&#46;827 pacientes con s&#237;ndrome coronario agudo &#40;edad media 65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13 a&#241;os&#44; 26&#44;4&#37; mujeres&#41;&#46; Se analiz&#243; la influencia del h&#225;bito tab&#225;quico o de la condici&#243;n de exfumador en la mortalidad mediante an&#225;lisis multivariados&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Los fumadores eran m&#225;s j&#243;venes&#44; m&#225;s frecuentemente hombres&#44; ten&#237;an menos diabetes&#44; hipertensi&#243;n e historia previa de insuficiencia cardiaca&#44; ictus&#44; arritmia e insuficiencia renal&#44; as&#237; como m&#225;s frecuentemente elevaci&#243;n del ST e historia familiar&#46; Los exfumadores presentaban m&#225;s dislipidemia e historia de angina&#44; infarto de miocardio&#44; cardiopat&#237;a isqu&#233;mica&#44; vasculopat&#237;a perif&#233;rica y broncopat&#237;a cr&#243;nica&#46; Fumadores y exfumadores desarrollaron menos frecuentemente shock cardiog&#233;nico &#40;fumadores 4&#44;2&#37;&#44; exfumadores 4&#44;7&#37; y no fumadores 6&#44;9&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; La mortalidad hospitalaria fue del 7&#44;8&#37; en los no fumadores&#44; un 4&#44;9&#37; en los exfumadores y un 3&#44;1&#37; en los fumadores &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; En el an&#225;lisis multivariado&#44; el car&#225;cter fumador perdi&#243; su influencia en el pron&#243;stico &#40;&#8211;0&#44;26&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;52 mediante c&#225;lculo de probabilidad inversa&#59; y &#43;0&#44;26&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;691 mediante an&#225;lisis de propensi&#243;n&#41;&#46; Sin embargo&#44; el car&#225;cter exfumador mostr&#243; una reducci&#243;n significativa de la mortalidad en ambos test &#40;&#8211;2&#44;4&#37; en el an&#225;lisis de probabilidad inversa&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#44; y &#8211;1&#44;5&#37; en el an&#225;lisis de propensi&#243;n&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La paradoja del tabaco es un hallazgo que puede explicarse por otros factores pron&#243;sticos&#46; El abandono del h&#225;bito tab&#225;quico previo a un ingreso por s&#237;ndrome coronario agudo se asocia a un mejor pron&#243;stico&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The tobacco paradox is a phenomenon insufficiently explained by previous studies&#46; This study analyses the prognostic role of prior or active smoking in patients with acute coronary syndrome&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We obtained data from the ARIAM registry&#44; between 2001 and 2012&#46; The study included 42&#44;827 patients with acute coronary syndrome &#40;mean age&#44; 65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13 years&#59; 26&#46;4&#37; women&#41;&#46; The influence of smoking and that of being an ex-smoker on mortality was analysed using a multivariate analysis&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The smokers were younger&#44; were more often men&#44; had less diabetes&#44; hypertension and prior history of heart failure&#44; stroke&#44; arrhythmia and renal failure and more frequently had ST-elevation and a family history of smoking&#46; The ex-smokers had more dyslipidaemia and history of angina&#44; myocardial infarction&#44; ischemic heart disease&#44; peripheral vasculopathy and chronic bronchial disease&#46; Smokers and ex-smokers less frequently developed cardiogenic shock &#40;smokers 4&#46;2&#37;&#44; ex-smokers 4&#46;7&#37; and nonsmokers 6&#46;9&#37;&#44; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#46; Hospital mortality was 7&#46;8&#37; for the nonsmokers&#44; 4&#46;9&#37; for the ex-smokers and 3&#46;1&#37; for the smokers <span class="elsevierStyleItalic">&#40;P</span>&#60;&#46;001&#41;&#46; In the multivariate analysis&#44; the smoker factor lost its influence in the prognosis &#40;&#8211;0&#46;26&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;52 using an inverse probability calculation&#59; and<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>0&#46;26&#37;&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;691 using a propensity analysis&#41;&#46; However&#44; the exsmoker factor showed a significant reduction in mortality in both tests &#40;-2&#46;4&#37; in the inverse probability analysis&#44; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#59; and &#8211;1&#46;5&#37; in the propensity analysis&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;005&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The tobacco paradox is a finding that could be explained by other prognostic factors&#46; Smoking cessation prior to hospitalization for acute coronary syndrome is associated with a better prognosis&#46;</p></span>"
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Edad&#44; a&#241;os<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;4<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;8<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Factores de riesgo cardiovascular</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;111 &#40;34&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;779 &#40;40&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dislipidemia&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;288 &#40;37&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;032 &#40;44&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;441 &#40;38&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>HTA&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;423 &#40;38&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;050 &#40;55&#44;2&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;977 &#40;61&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Obesidad&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;595 &#40;11&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;035 &#40;11&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;104 &#40;10&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;456&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Historia familiar&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;859 &#40;13&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">773 &#40;8&#44;4&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;335 &#40;6&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Antecedentes</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Angina&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;468 &#40;17&#44;3&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;813 &#40;30&#44;7&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;077 &#40;26&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IAM&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;642 &#40;11&#44;5&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;544 &#40;27&#44;8&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;380 &#40;17&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lesiones coronarias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">513 &#40;3&#44;6&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">831 &#40;9&#44;1&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;139 &#40;5&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IC&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">245 &#40;1&#44;7&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">577 &#40;6&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;159 &#40;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>AVC&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">464 &#40;3&#44;2&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">596 &#40;6&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;336 &#40;6&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Arritmia&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">337 &#40;2&#44;4&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">663 &#40;7&#44;2&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;598 &#40;8&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vasculopat&#237;a&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">635 &#40;4&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">767 &#40;8&#44;4&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">778 &#40;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>EPOC&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">728 &#40;8&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">501 &#40;2&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IR&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">393 &#40;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Forma presentaci&#243;n</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ST elevado&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46;763 &#40;56&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Killip<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>2 al ingreso&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;090 &#40;15&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;980 &#40;26&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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Original
DOI: 10.1016/j.rce.2016.03.006
La paradoja del tabaco en el síndrome coronario agudo. El abandono previo del hábito tabáquico como marcador de mejor pronóstico a corto plazo
The tobacco paradox in acute coronary syndrome. The prior cessation of smoking as a marker of a better short-term prognosis
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P. Bastos-Amadora, M. Almendro-Deliaa, B. Muñoz-Caleroa, E. Blanco-Ponceb, A. Recio-Mayoralb, A. Reina-Toralb, J.M. Cruz-Fernandezc, A. García-Alcántarac, R. Hidalgo-Urbanoa, J.C. García-Rubiraa,
Autor para correspondencia
grubira1@gmail.com

Autor para correspondencia.
, Grupo SCA plataforma Ariam-Andalucía
a Unidad de Gestión de Cardiología, Hospitales Universitarios Virgen Macarena-Virgen del Rocío, Sevilla, España
b Unidad de Cuidados Intensivos, Hospital Virgen de las Nieves, Granada, España
c Unidad de Cuidados Intensivos, Hospital Virgen de la Victoria, Málaga, España
Contenido relacionado
La paradoja del tabaco
Rev Clin Esp. 2016;216:308-1010.1016/j.rce.2016.06.001
D. Sánchez Fuentes, M.A. Budiño Sánchez

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