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Is Alice still in Wonderland of the ‘smoker’s paradox’? A meta-analysis of mortality following ACS

September 2014 Br J Cardiol 2014;21:117 doi:10.5837/bjc.2014.028

Is Alice still in Wonderland of the ‘smoker’s paradox’? A meta-analysis of mortality following ACS

Hisato Takagi, Takuya Umemoto; for the ALICE (All-Literature Investigation of Cardiovascular Evidence) Group

Abstract

Introduction Following observations that smokers experience decreased mortality following acute myocardial infarction (acute MI [AMI]) in comparison with non-smokers,1 the term ‘smoker’s paradox’ was introduced into scientific discourse more than 25 years ago.2 The ‘smoker’s paradox’ following various reperfusion strategies, however, is argued not to be due to any benefit from smoking itself but simply due to smokers being likely to undergo such procedures at a much younger age, and, hence, having, on average, lower comorbidity. In a recent systematic review (with a search by September 2010)2 of 17 studies presenting adjusted tota

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