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Comparison of the survival and neurological outcomes in OHCA based on smoking status: investigation of the existence of the smoker's paradox

 Gina Yu  ;  Taeyoung Kong  ;  Je Sung You  ;  Yoo Seok Park  ;  Hye Sun Lee  ;  Sung Phil Chung 
 SIGNA VITAE, Vol.18(2) : 121-129, 2022-03 
Journal Title
Issue Date
Smokers ; Ex-smokers ; Non-smokers ; Cardiac arrest ; Propensity score
The smoker’s paradox has been reported to reduce mortality following out-of-hospital cardiac arrest (OHCA). However, recent studies on this paradox have reported contradictory findings, with some indicating that it does not exist. Therefore, the purpose of this study was to evaluate the association between smoking status and OHCA outcomes. This retrospective observational study was conducted using multicenter registry data. The associations between smoking status and OHCA outcomes were assessed using multivariable logistic regression analyses and propensity score-adjusted methods. We compared outcomes among current, former, and never-smokers, as well as between current and non-smokers and between ever- and never-smokers. The primary outcome was survival to hospital discharge, and the secondary outcome was favourable neurological outcomes. Among 4443 patients with OHCA, 19.9% were current smokers, 15.2% were former smokers, and 64.9% were never-smokers. Current smokers had significantly better outcomes than former or never-smokers. However, the significant differences observed in univariable analysis or before propensity score matching were not observed after adjustments with multivariable logistic regression or after propensity score matching analysis in both current vs. non-smokers and ever- vs. never-smokers. Other propensity score adjusted models also did not show significant differences, except for the stratification method. This study suggests that smoking is not an independent prognostic factor for OHCA. The statistically significant better outcomes observed in current or ever-smokers were not maintained after adjusting for confounders. Therefore, the smoker’s paradox should be investigated in additional prospective studies.
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1. College of Medicine (의과대학) > Dept. of Emergency Medicine (응급의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kong, Tae Young(공태영) ORCID logo https://orcid.org/0000-0002-4182-7245
Park, Yoo Seok(박유석) ORCID logo https://orcid.org/0000-0003-1543-4664
You, Je Sung(유제성) ORCID logo https://orcid.org/0000-0002-2074-6745
Yu, Gina(유지나)
Lee, Hye Sun(이혜선) ORCID logo https://orcid.org/0000-0001-6328-6948
Chung, Sung Phil(정성필) ORCID logo https://orcid.org/0000-0002-3074-011X
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