Comparative Assessment of Thrombus Burden in Smokers and Non-Smokers with STEMI: Insights from Primary PCI

Abstract

Objectives: Cigarette smoking is a well-established determinant of atherothrombosis and a major risk factor for early-onset coronary artery disease. Among patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI), smokers often present at a younger age with distinct clinical and angiographic characteristics, including increased thrombus burden. These factors may influence procedural complexity, periprocedural complications, and long-term outcomes. However, the relationship between smoking, thrombus burden, and procedural outcomes in STEMI remains inadequately defined. Methodology: A total of 189 patients presenting with acute STEMI were analyzed and stratified by smoking status (58 smokers vs. 131 non-smokers) and thrombus burden (106 low vs. 83 high). Baseline demographics, comorbidities, infarct characteristics, and procedural outcomes were compared between groups. Results: Smokers were significantly younger than non-smokers (43.4 ± 7.6 vs. 56.7 ± 8.2 years, p = 0.036), with otherwise similar comorbidity profiles. Pre-procedural Thrombolysis In Myocardial Infarction (TIMI) flow was more frequent among smokers (41% vs. 25%, p = 0.047). High thrombus burden was independently associated with smoking (50% vs. 16%, p < 0.001), increased use of thrombus aspiration, and higher rates of slow-flow/no-reflow phenomena. Despite these differences, procedural success rates (~95%) and in-hospital mortality were comparable between smokers and non-smokers. Conclusion: Smokers with STEMI present at a younger age and exhibit significantly higher thrombus burden and procedural challenges; however, overall procedural success and short-term outcomes remain similar to those of non-smokers. These observations underscore smoking cessation as the central target for secondary prevention.