[Effect of tobacco smoking on the incidence of recurrent myocardial infarction. A retrospective study of 208 cases].

Two hundred and eight patients, less than 60 years of age at the time of their first myocardial infarction (MI), which occurred between 1 July 1976 and 30 September 1982, and with a mean recurrence-free follow-up period of 3450 +/- 142 days, were included in a retrospective survey. This concerned the outcome of their coronary artery disease and the persistence of vascular risk factors, notably their tobacco consumption, the extent and forme of which was detailed. This study showed: 1) the mortality rate was 8.8%, 2) 78.4% of the patients smoked before their infarction, 3) 76% of the smokers stopped smoking after this event. The risk of recurrence of infarction was higher amongst smokers. After 5 years, 51.6 +/- 15% of the subjects who had not reduced their daily tobacco consumption had suffered another MI, versus 21.5 +/- 3% of those who had reduced it by 1 to 50%, 16.9 +/- 6% of those who had never smoked and only 10.5 +/- 6% of those who had reduced it by more than 50% or had stopped smoking (p less than 0.02). The relative risk of recurrence of infarction in persistent smokers was 4.4 times that in subjects who had stopped smoking. However, no significant difference was found between the mortality in the various subgroups. In addition to smoking, only two factors were found to significantly promote the onset of a fresh MI: an initial infarction with no Q wave (p = 0.007), and the persistence of spontaneous angina pectoris (p = 0.0009).