CCCardiol CroatCardiologia CroaticaCardiol. Croat.1848-543X1848-5448Croatian Cardiac SocietyCC 2026 21_1-2_41-210.15836/ccar2026.41Extended AbstractInterdisciplinary approach to the patient with cardiovascular diseaseCardiac functional recovery after acute coronary syndrome: a comparison between smokers and non-smokershttps://orcid.org/0000-0002-8909-9216KovačevićAna1*https://orcid.org/0000-0002-7779-9805KovačevićStjepan1https://orcid.org/0009-0002-4123-0171DumančićIva1KovačevićMarijana1https://orcid.org/0009-0003-3553-3229FranićMaja1https://orcid.org/0009-0009-9454-9785MeterJosipa1https://orcid.org/0000-0002-7655-6078BukalNikolina1https://orcid.org/0000-0002-2650-4405LekoNinoslav1https://orcid.org/0000-0001-6188-0708Cvitkušić LukendaKatica12General Hospital “Dr. Josip Benčević”, Slavonski Brod, CroatiaJosip Juraj Strossmayer University of Osijek, Faculty of Dental Medicine and Health Osijek, Osijek, CroatiaADDRESS FOR CORRESPONDENCE: Ana Kovačević, Opća bolnica “Dr. Josip Benčević“, Andrije Štampara 42, HR-35000 Slavonski Brod, Croatia. / Phone number: +385-98-976-0629 / E-mail: ana.bardak@gmail.com122025122025211-241421910202514112025Croatian Cardiac Society2025Croatian Cardiac SocietyKEYWORDS: acute coronary syndromesmokingcardiac functional recovery
Introduction: Smoking is a well-established risk factor for the development of acute coronary syndrome (ACS). (1) Beyond its role in disease onset, smoking has been associated with adverse outcomes during follow-up. (2) While several studies have examined the impact of smoking cessation on cardiac recovery, few have directly compared smokers and non-smokers with respect to functional cardiac recovery following ACS. (3) The aim of this study was to evaluate differences in cardiac functional recovery between smokers and non-smokers after ACS.
Patients and Methods: This retrospective study included patients hospitalized with ACS between January and December 2023. Patients were classified as smokers or non-smokers. Variables included demographics, comorbidities, MACE score, troponin, stenosis extent, hypokinesia, diastolic dysfunction, and echocardiographic changes. Analyses were performed using SPSS 26. Categorical variables were compared with Fisher’s exact or Chi-square tests, and continuous variables with Student’s t-test or Mann–Whitney U test. A two-tailed p < 0.05 was considered significant.
Results: The study included 42 patients. The mean age of smokers was 61.4 years (SD 12.1) and 67.0 years (SD 7.9) for non-smokers (Student’s t-test, p = 0.09; 95% CI: −0.8 to 11.9). Among smokers, the median pack-years was 33 (IQR 24–50). Baseline and clinical characteristics (Table 1) and echocardiographic parameters (Table 2) showed no significant differences between groups. Although non-smokers showed greater improvement in left ventricular ejection fraction (LVEF) (mean Δ 4.6%, SD 6.9) compared to smokers (mean Δ 1.4%, SD 13.3), the difference was not statistically significant (Student’s t-test, p = 0.3; 95% CI: −3.5 to 9.8) (Figure 1). A slight, non-significant increase in left ventricular (LV) dimension was observed in smokers (median Δ 1 cm, IQR −2 to 4; Mann–Whitney U test, p = 0.4), suggesting a possible trend toward adverse LV remodeling (Figure 2). Left atrial (LA) dimension remained unchanged in both groups.
Baseline and clinical characteristics according to smoking status.
N (%)
P*
Smokers
Non-smokers
Total
Gender
Male
13 (44.8)
16 (55.2)
29 (69)
0.32
Female
8 (61.5)
5 (38.5)
13 (31)
Coronary stenosis
Single-vessel disease
10 (58.8)
7 (41.2)
17 (40.5)
0.35
Multivessel disease
11 (44)
14 (56)
25 (59.5)
Improved hypokinesia
3 (37.5)
5 (62.5)
8 (19)
0,7†
Improved diastolic dysfunction
1 (33.3)
2 (66.7)
3 (7.1)
>0.99†
Hyperlipidemia
17 (53.1)
15 (46.9)
32 (76.2)
0.5
Hypertension
13 (46.4)
15 (53.6)
28 (66.7)
0.51
Diabetes mellitus
5 (83.3)
1 (16.7)
6 (14.3)
0.18†
COPD
2 (100)
0 (0)
2 (4.8)
0.49†
*χ2 test; †Fisher’s exact test
Comparison of cardiac recovery between smokers and non-smokers after acute coronary syndrome.
Median (IQR)
P*
Smokers
Non-smokers
LVEF (%)
Baseline value
55 (45-62)
57 (45-60)
0.6
Follow-up value
60 (52-62)
60 (49-67)
0.6
Left ventricle (cm)
Baseline value
51 (45-53)
52 (46-56)
0.7
Follow-up value
54 (46-56)
52 (48-54)
0.8
Left atrium (cm)
Baseline value
42 (38-43)
42 (36-45)
>0.9
Follow-up value
42 (38-43)
39 (35-43)
0.2
* Mann Whitney U test
Change in left ventricular ejection fraction (LVEF; %) over time (initial vs. follow-up) in smokers and non-smokers.
Change in left ventricular (LV) and left atrial (LA) dimensions (cm) over time (initial vs. follow-up) in smokers and non-smokers.
Conclusion: This study found no statistically significant difference in cardiac recovery after ACS between smokers and non-smokers. However, a trend toward less favorable remodeling in smokers was observed. Given the small sample size and self-reported smoking status, further larger studies are needed to confirm these findings and clarify the clinical impact.
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