The Correlation Between Cumulative Cigarette Consumption and Infarction-Related Coronary Spasm in Patients with ST-Segment Elevation Acute Myocardial Infarction Across Different Age Groups

The Correlation Between Cumulative Cigarette Consumption and Infarction-Related Coronary Spasm in Patients with ST-Segment Elevation Acute Myocardial Infarction Across Different Age Groups | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The Correlation Between Cumulative Cigarette Consumption and Infarction-Related Coronary Spasm in Patients with ST-Segment Elevation Acute Myocardial Infarction Across Different Age Groups Zhihui Kuang, Lin Lin, Ranran Kong, Zhonghua Wang, Xianjun Mao, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4933356/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 02 Jan, 2025 Read the published version in Scientific Reports → Version 1 posted 10 You are reading this latest preprint version Abstract Background: Coronary artery spasm (CAS) is a significant contributor to the pathogenesis of acute ST-elevation myocardial infarction (STEMI). Although smoking is a well-established risk factor for CAS, the relationship between cumulative cigarette consumption and infarction-related CAS across different age groups in STEMI patients remains unclear. This study aims to investigate how age modulates this correlation. Materials and Methods: We conducted a retrospective study of STEMI patients who underwent coronary angiography (CAG) at the General Hospital of Southern Theater Command from December 2014 to March 2018. Inclusion criteria were: patients aged 18 years or older with confirmed STEMI and CAS. Exclusion criteria included absence of CAG, significant comorbidities, and incomplete data. Patients were categorized into CAS and non-CAS groups and further stratified by age into young adults (≤45 years), middle-aged (46-59 years), and elderly (≥60 years). Cumulative cigarette consumption was assessed using the smoking index. Statistical analyses evaluated correlations between smoking and CAS by age group. The approval for this study was obtained from the Ethics Committee of General Hospital of Southern Theater Command (2018-54). Since data were evaluated retrospectively, anonymously, and solely obtained for the study purposes, a requirement of informed consent was waived by General Hospital of Southern Theater Command ethics committee. All study methods were performed in accordance with Helsinki Declaration. Ethical approval and consent to participate This study was approved by the ethics committee of General Hospital of Southern Theater Command (2018-54). Results: Of 1156 STEMI patients, 80 (6.9%) had CAS. The CAS group had a higher prevalence of young adults (35% vs. 13.8%, P < 0.001) and heavy smokers (62.5% in CAS vs. 46.6% in non-CAS, P < 0.001). Heavy smoking correlated with CAS in young adults (r = 0.321, P < 0.001) and middle-aged patients (r = 0.127, P = 0.006), but not in the elderly. Logistic regression revealed that heavy smoking significantly increased the risk of CAS, with adjusted odds ratios of 6.397 for grade 2 smokers and 6.926 for grade 3 smokers compared to non-smokers. Among heavy smokers, the risk of CAS was 4.912 times higher in young adults and 2.041 times higher in middle-aged patients compared to the elderly. Conclusion: Cumulative cigarette consumption is positively correlated with infarction-related CAS in STEMI patients. Heavy smoking is a major risk factor for CAS, especially in young and middle-aged individuals. Effective smoking control is essential for preventing and managing STEMI, particularly among younger and middle-aged populations in China. Health sciences/Cardiology/Interventional cardiology Health sciences/Diseases/Cardiovascular diseases Cumulative cigarette consumption Infarction-related coronary spasm Acute myocardial infarction ST-segment elevation Coronary angiography Introduction Coronary artery spasm (CAS) plays a critical role in the pathogenesis of acute ST-elevation myocardial infarction (STEMI) 1 – 6 . Smoking is recognized as a major risk factor for CAS 7 – 9 , yet the relationship between cumulative cigarette consumption and infarction-related CAS across various age groups in STEMI patients remains ambiguous. This study aims to elucidate whether age influences the correlation between cumulative cigarette consumption and infarction-related CAS in STEMI patients. Materials and Methods Inclusion Criteria: 1. Patients diagnosed with STEMI who underwent coronary angiography (CAG) at the General Hospital of Southern Theater Command from December 2014 to March 2018, in accordance with the 2017 European Society of Cardiology (ESC) guidelines 5 . 2. Patients aged 18 years or older. 3. Patients with CAS confirmed by CAG. 4. Chinese nationality. Exclusion Criteria: 1. STEMI diagnosis based solely on clinical symptoms without CAG. 2. History of myocardial infarction, chronic heart conditions, or other significant cardiovascular diseases. 3. Severe renal, hepatic, or systemic disorders affecting clinical outcomes. 4. Missing medical data. Diagnostic Criteria for CAS: CAS was diagnosed based on CAG findings according to standard definitions . CAS as a cause of STEMI was identified if CAG met one of the following criteria in the absence of other plausible causes:Total occlusion or severe stenosis of the infarction-related coronary artery that resolves spontaneously or with vasodilator administration. 1. Infarction-related coronary artery showed total occlusion or severe stenosis that spontaneously resolved or improved after intra-coronary administration of nitroglycerin or other vasodilators. 2. Infarction-related coronary artery appeared normal but exhibited transitional spasm during CAG or follow-up. 3. Onset of chest pain with ST-segment elevation in two or more adjacent leads on ECG, with relief of pain and ST-segment resolution, and no stenosis or thrombus in the infarction-related coronary artery on CAG. Grouping and Smoking Index Calculation: Patients were categorized into CAS and non-CAS groups based on CAG results, and further divided by age into young adults (≤45 years), middle-aged adults (46-59 years), and elderly adults (≥60 years). Cumulative cigarette consumption was calculated using the smoking index 10 , which is the product of daily cigarette consumption and number of years smoking. Smoking was categorized as follows: grade 0 (non-smokers), grade 1 (smoking index ≤100), grade 2 (smoking index ≤200), and grade 3 (smoking index >200). Statistical Analysis: Data were analyzed using SPSS 21.0. Descriptive statistics, parametric or nonparametric tests, and chi-square tests were employed for comparisons. Spearman rank correlation assessed the relationship between smoking and CAS. Multivariate logistic regression evaluated associations between smoking and CAS. Results 1.Risk Factors Comparison : Among 1156 STEMI patients, 80 (6.9%) had CAS, with a higher prevalence of young adults and heavy smokers in the CAS group. The proportion of middle-aged and elderly patients, as well as those with diabetes and hypertension, was significantly lower in the CAS group (Table 1 ). Table 1 Baseline Characteristics of CAS and Non-CAS Groups Risk Factor CAS Group (n = 80) Non-CAS Group (n = 1076) P Value Age Groups, n (%) Young Adults 28 (35.0) 148 (13.8) < 0.001 Middle-Aged 30 (37.5) 431 (40.1) 0.652 Old 22 (27.5) 497 (46.2) 0.001 Gender, n (%) Male 70 (87.5) 896 (83.3) 0.325 Female 10 (12.5) 180 (16.7) Cigarette Consumption, n (%) Grade 0 16 (20.0) 476 (44.2) < 0.001 Grade 1 5 (6.3) 35 (3.3) 0.004 Grade 2 9 (11.3) 64 (5.9) 0.002 Grade 3 50 (62.5) 501 (46.6) 0.006 Family History of Early CAD, n (%) 3 (3.8) 29 (2.7) 0.563 Hypercholesterolemia, n (%) 13 (16.3) 270 (25.1) 0.076 Alcoholism, n (%) 54 (74.0) 765 (77.5) 0.487 Diabetes, n (%) 14 (17.5) 373 (34.7) 0.002 Hypertension, n (%) 18 (22.5) 467 (43.4) < 0.001 BMI (Mean ± SD) 23.76 ± 3.63 24.15 ± 3.28 0.537 BMI: Body Mass Index. 2.Age Group Comparison : Varying risk factors were observed among young adults (15.2%), middle-aged (39.9%), and elderly (44.9%) groups. Smoking, particularly heavy smoking, was more common in younger and middle-aged patients compared to the elderly (Table 2 ). Table 2 Distribution of Risk Factors Among STEMI Patients in Different Age Groups Risk Factor Young Adults (n = 176) Middle-Aged (n = 461) Old (n = 519) P Value Gender, n (%) Male 171 (97.2) 420 (91.1) 375 (72.3) < 0.001 Female 5 (2.8) 41 (8.9) 144 (27.7) Family History of Early CAD, n (%) 11 (6.2) 18 (3.9) 3 (0.6) < 0.001 Alcoholism, n (%) 61 (34.7) 109 (23.6) 71 (13.7) < 0.001 Overweight, n (%) 92 (52.3) 185 (40.1) 155 (29.9) < 0.001 Hypercholesterolemia, n (%) 53 (30.1) 119 (25.8) 111 (21.4) < 0.001 Diabetes, n (%) 41 (23.9) 167 (36.2) 178 (34.3) < 0.001 Hypertension, n (%) 49 (27.8) 174 (37.7) 262 (50.5) < 0.001 Cigarette Consumption, n (%) Grade 0 38 (21.6) 160 (34.7) 295 (56.8) < 0.001 Grade 1 23 (13.1) 8 (1.7) 7 (1.3) < 0.001 Grade 2 35 (19.9) 23 (5.0) 15 (2.9) < 0.001 Grade 3 80 (45.4) 270 (58.6) 202 (38.9) < 0.001 Heavy Smoking (Grades 2 and 3), n (%) 115 (65.3) 293 (63.6) 217 (41.8) < 0.001 P < 0.05: Significant difference from the old group. P < 0.01: Highly significant difference from the old group. + P < 0.05, ++ P < 0.01 vs. the middle-aged group. 3.Correlation Analysis : A positive correlation between cumulative cigarette consumption and CAS was found in all patients. Heavy smoking correlated with CAS in young adults and middle-aged patients, but not in the elderly (Tables 3 – 6 ). Table 3 Correlation Between Smoking and Infarction-Related CAS in All Patients Smoking Infarction-Related CAS Spearman rho-value r = 0.124** Significance (Two-Tailed Test) p = 0.000 N 1156 *rho: Correlation coefficient; Sig.: p value; *: Significant correlation at p < 0.01. Table 4 Correlation Between Heavy Smoking (Grades 2 and 3) and Infarction-Related CAS in the Young Adult Group Heavy Smoking (Grades 2 and 3) Infarction-Related CAS Spearman rho-value r = 0.321** Significance (Two-Tailed Test) p = 0.000 N 176 *rho: Correlation coefficient; Sig.: p value; *: Significant correlation at p < 0.01. Table 5 Correlation Between Heavy Smoking (Grades 2 and 3) and Infarction-Related CAS in the Middle-Aged Group Heavy Smoking (Grades 2 and 3) Infarction-Related CAS Spearman rho-value r = 0.127** Significance (Two-Tailed Test) p = 0.006 N 461 *rho: Correlation coefficient; Sig.: p value; *: Significant correlation at p < 0.01. Table 6 Correlation Between Heavy Smoking (Grades 2 and 3) and Infarction-Related CAS in the Old Group Heavy Smoking (Grades 2 and 3) Infarction-Related CAS Spearman rho-value r = 0.016 Significance p = 0.724 N 519 rho: Correlation coefficient; Sig.: p value. 4.Logistic Regression Analysis : Heavy smoking significantly increased the risk of CAS, with adjusted odds ratios of 6.397 for grade 2 smokers and 6.926 for grade 3 smokers compared to non-smokers. The risk of CAS was 4.912-fold higher in young adults and 2.041-fold higher in middle-aged patients compared to the elderly (Table 7 ). Table 7 Multivariate Logistic Regression Analysis of Infarction-Related CAS Variable B S.E. Wald χ² P Value OR a 95% CI Cigarette Consumption Grade 1 -1.105 0.801 1.902 0.168 3.018 0.628–14.499 Grade 2 -1.856 0.527 12.409 0.000 6.397 2.278–17.963 Grade 3 -1.935 0.402 23.142 0.000 6.926 3.148–15.239 Cigarette Consumption and Age Grade 1 and the Young Adult Group 1.053 0.656 2.575 0.109 2.866 0.792–10.375 Grade 1 and the Middle-Aged Group 1.143 1.096 1.088 0.297 3.137 0.366–26.897 Grades 2 and 3 and the Young Adult Group 1.592 0.315 25.607 0.000 4.912 2.652–9.100 Grades 2 and 3 and the Middle-Aged Group 0.713 0.291 6.009 0.014 2.041 1.154–3.609 OR: Odds Ratio; B: Partial Regression Coefficient; S.E.: Standard Error; a OR values are adjusted for diabetes mellitus, hypercholesterolemia, and hypertension. The analysis was performed using multivariate logistic regression with a stepwise entry method. The inclusion criteria for study factors were p < 0.05, and the exclusion criteria were p < 0.10. Two-tailed p < 0.05 was considered statistically significant. Discussion 1.Association Between Cumulative Cigarette Consumption and Infarction-Related Coronary Spasm (CAS) in STEMI Patients: Our findings corroborate prior research indicating a significant positive correlation between cumulative cigarette consumption and infarction-related CAS in patients with ST-segment elevation myocardial infarction (STEMI). A controlled study by Xiang et al. 7 involving 275 patients identified smoking as a critical risk factor for CAS, elevating the risk by a factor of 4.2. Our current data further affirm that the probability of CAS in STEMI patients is directly proportional to smoking intensity. Specifically, compared to non-smokers, the risk of infarction-related CAS is 6.397-fold higher among grade 2 smokers and 6.926-fold higher among grade 3 smokers. The underlying mechanism through which smoking contributes to CAS involves the activation of inflammatory pathways and the enhancement of oxidative stress 11,12 . Additionally, smoking impairs endothelial nitric oxide (NO) production 13 and directly damages endothelial cells, resulting in endothelial dysfunction 14 . Sugiishi et al. 15 demonstrated that smoking induces a dose-dependent and potentially reversible impairment in endothelial-dependent vasodilation in young and middle-aged individuals, often without overt clinical symptoms. Consequently, smoking induces endothelial dysfunction, with more extensive smoking leading to greater endothelial damage and heightened susceptibility to CAS. 2.Impact of Heavy Smoking on Infarction-Related CAS in Young STEMI Patients :Previous research by Xiang et al. 7 has shown that CAS predominantly affects young men under the age of 35, with smoking identified as the principal risk factor. Notably, young males are more likely to be heavy smokers. Gulati et al. 16 have indicated that acute myocardial infarction (AMI) with normal coronary arteries can result from persistent CAS, with young heavy smokers being particularly vulnerable. Tolstrup et al. 17,18 followed 4,326 patients with coronary heart disease and observed that the risk of coronary heart disease among smokers was highest in younger patients and lowest in older patients. The study by Imazio et al. 18 further found that smoking, dyslipidemia, and family history of coronary heart disease were significantly more prevalent among young and middle-aged AMI patients compared to older individuals, who more frequently exhibited diabetes and hypertension. Our study confirms that young and middle-aged STEMI patients exhibit high rates of smoking, which is positively correlated with CAS 19 . Furthermore, heavy smoking emerges as a major risk factor for STEMI-related CAS. Specifically, heavy smoking (grades 2 and 3) among young and middle-aged subjects is associated with a 4.912-fold and 2.041-fold increased risk of infarction-related CAS, respectively, compared to older patients. The susceptibility of young individuals to CAS may be attributed to a confluence of risk factors, primarily smoking and hyperlipidemia 20 . Both smoking and hyperlipidemia independently elevate the risk of CAS by 3.2-fold and 1.3-fold, respectively 21 . In contrast, other risk factors such as hypertension and diabetes are more prevalent among middle-aged and older populations, and often present compounded risks when combined 22 . Thus, smoking represents a substantial risk factor for infarction-related CAS in young STEMI patients. Conclusion This study highlights a significant positive correlation between cumulative cigarette consumption and infarction-related CAS in STEMI patients. Heavy smoking (grades 2 and 3) is identified as a major risk factor for CAS in young and middle-aged STEMI patients. Effective smoking cessation strategies are crucial for the prevention and management of STEMI, particularly targeting the young and middle-aged demographic in China. Declarations Acknowledgements: We acknowledge the dedicated efforts of all staff involved in implementing the intervention and evaluation components of the study. Authors’ Contributions: Zhihui Kuang and Ranran Kong conceived and designed the study. Zhonghua Wang and Zhihui Kuang collected the data. Zhihui Kuang and Dingcheng Xiang analyzed the data. Dingcheng Xiang, Zhihui Kuang, and Lin Lin drafted the manuscript. Xianjun Mao and Lin Lin reviewed the manuscript. All authors read and approved the final draft. Funding: This study was supported by the Medical Science and Technology Research Fund of Guangdong Province (No. 202311694435185) and the Science and Technology Project of Hunan Province (No. 2015JC3131). Competing Interests: The authors declare no competing interests. Availability of Data and Materials: All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author. References Thygesen, K. et al. Fourth Universal Definition of Myocardial Infarction (2018). Journal of the American College of Cardiology 72, 2231-2264, doi:10.1016/j.jacc.2018.08.1038 (2018). Maseri, A. et al. Coronary vasospasm as a possible cause of myocardial infarction. A conclusion derived from the study of "preinfarction" angina. The New England journal of medicine 299, 1271-1277, doi:10.1056/nejm197812072992303 (1978). Wang, C. H., Kuo, L. T., Hung, M. J. & Cherng, W. J. 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Falsoleiman, H., Bayani, B., Dehghani, M., Moohebati, M. & Rohani, A. Global coronary arteries spasm in a young patient. ARYA atherosclerosis 9, 260-262 (2013). Xiang，D, Zeng，D & Huo，Y. Diagnosis and treatment of coronary artery spasm syndrome,Consensus of Chinese experts. Chinese journal of interventional cardiology 23, 181-186., doi:10.3969/j.issn.1004-8812.2015.04.001 (2015). Gao，X & Yang，J. Analysis of cardiovascular risk factors in patients with acute myocardial infarction in China. Chinese circulation journal 30, 206-210, doi:CNKI:SUN:ZGGZ.0.2016-01-037 (2015). (2015). Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4933356","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":358159674,"identity":"836e43db-ee63-4a71-958d-545b723dbd99","order_by":0,"name":"Zhihui Kuang","email":"","orcid":"","institution":"The First Clinical College of Jinan University, Jinan University","correspondingAuthor":false,"prefix":"","firstName":"Zhihui","middleName":"","lastName":"Kuang","suffix":""},{"id":358159675,"identity":"85dbfd43-2f31-42b6-8136-e505dfb206f5","order_by":1,"name":"Lin Lin","email":"","orcid":"","institution":"Puning People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Lin","middleName":"","lastName":"Lin","suffix":""},{"id":358159676,"identity":"bab5151b-08e0-4662-8663-aa343a87b0e2","order_by":2,"name":"Ranran Kong","email":"","orcid":"","institution":"Southern Medical University","correspondingAuthor":false,"prefix":"","firstName":"Ranran","middleName":"","lastName":"Kong","suffix":""},{"id":358159677,"identity":"1b2e1f59-85fe-46a7-aa88-5c8df3263857","order_by":3,"name":"Zhonghua Wang","email":"","orcid":"","institution":"The First People’s Hospital of Chenzhou","correspondingAuthor":false,"prefix":"","firstName":"Zhonghua","middleName":"","lastName":"Wang","suffix":""},{"id":358159679,"identity":"22b7d44f-7af2-4d7d-b7a3-3c2cb9743eac","order_by":4,"name":"Xianjun Mao","email":"","orcid":"","institution":"The First People’s Hospital of Chenzhou","correspondingAuthor":false,"prefix":"","firstName":"Xianjun","middleName":"","lastName":"Mao","suffix":""},{"id":358159680,"identity":"2eb39aca-cd59-41a6-9f57-ea832f8a72ab","order_by":5,"name":"Dingcheng Xiang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAx0lEQVRIiWNgGAWjYBACxmbGBuOff2qY7dsbiNTC3M7cUMzYcIzdgOcAkVrY+9kbPjM2MPMbSCQQqYW3mbFxc+EONmlzyccbbzDU2EQT1CLZzNhsPPOMjLHl7LRiC4ZjabkNhLQYNjO2GfCwsSUz3M4xk2BsOExYi/1hxvYfPGzM9Q03zxCpBRzIvG3MzAY3eEjQYjjjzDFmyR6gXxKI8Qtj//EHBh8qapj52Q9vvPGhxoawFmRAfNQgaSFVxygYBaNgFIwMAAA7QT58aFStzQAAAABJRU5ErkJggg==","orcid":"","institution":"General Hospital of Southern Theater Command","correspondingAuthor":true,"prefix":"","firstName":"Dingcheng","middleName":"","lastName":"Xiang","suffix":""}],"badges":[],"createdAt":"2024-08-18 12:39:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4933356/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4933356/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-024-84125-5","type":"published","date":"2025-01-02T15:57:34+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":73093516,"identity":"cad02053-2853-46ac-aeff-087ee4812a9e","added_by":"auto","created_at":"2025-01-06 16:21:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":741809,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4933356/v1/c6298085-c7f6-404d-82c9-c1dfd76da3d8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Correlation Between Cumulative Cigarette Consumption and Infarction-Related Coronary Spasm in Patients with ST-Segment Elevation Acute Myocardial Infarction Across Different Age Groups","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCoronary artery spasm (CAS) plays a critical role in the pathogenesis of acute ST-elevation myocardial infarction (STEMI)\u003csup\u003e\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Smoking is recognized as a major risk factor for CAS \u003csup\u003e\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e, yet the relationship between cumulative cigarette consumption and infarction-related CAS across various age groups in STEMI patients remains ambiguous. This study aims to elucidate whether age influences the correlation between cumulative cigarette consumption and infarction-related CAS in STEMI patients.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eInclusion Criteria:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1.\u0026nbsp; \u0026nbsp;Patients diagnosed with STEMI who underwent coronary angiography (CAG) at the General Hospital of Southern Theater Command from December 2014 to March 2018, in accordance with the 2017 European Society of Cardiology (ESC) guidelines\u0026nbsp;\u003csup\u003e5\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp; \u0026nbsp;Patients aged 18 years or older.\u003c/p\u003e\n\u003cp\u003e3.\u0026nbsp; \u0026nbsp;Patients with CAS confirmed by CAG.\u003c/p\u003e\n\u003cp\u003e4.\u0026nbsp; \u0026nbsp;Chinese nationality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion Criteria:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1.\u0026nbsp; \u0026nbsp;STEMI diagnosis based solely on clinical symptoms without CAG.\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp; \u0026nbsp;History of myocardial infarction, chronic heart conditions, or other significant cardiovascular diseases.\u003c/p\u003e\n\u003cp\u003e3.\u0026nbsp; \u0026nbsp;Severe renal, hepatic, or systemic disorders affecting clinical outcomes.\u003c/p\u003e\n\u003cp\u003e4.\u0026nbsp; \u0026nbsp;Missing medical data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiagnostic Criteria for CAS:\u003c/strong\u003e CAS was diagnosed based on CAG findings according to standard definitions . CAS as a cause of STEMI was identified if CAG met one of the following criteria in the absence of other plausible causes:Total occlusion or severe stenosis of the infarction-related coronary artery that resolves spontaneously or with vasodilator administration.\u003c/p\u003e\n\u003cp\u003e1.\u0026nbsp; \u0026nbsp;Infarction-related coronary artery showed total occlusion or severe stenosis that spontaneously resolved or improved after intra-coronary administration of nitroglycerin or other vasodilators.\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp; \u0026nbsp;Infarction-related coronary artery appeared normal but exhibited transitional spasm during CAG or follow-up.\u003c/p\u003e\n\u003cp\u003e3.\u0026nbsp; \u0026nbsp;Onset of chest pain with ST-segment elevation in two or more adjacent leads on ECG, with relief of pain and ST-segment resolution, and no stenosis or thrombus in the infarction-related coronary artery on CAG.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGrouping and Smoking Index Calculation:\u003c/strong\u003e Patients were categorized into CAS and non-CAS groups based on CAG results, and further divided by age into young adults (≤45 years), middle-aged adults (46-59 years), and elderly adults (≥60 years). Cumulative cigarette consumption was calculated using the smoking index\u0026nbsp;\u003csup\u003e10\u003c/sup\u003e, which is the product of daily cigarette consumption and number of years smoking. Smoking was categorized as follows: grade 0 (non-smokers), grade 1 (smoking index ≤100), grade 2 (smoking index ≤200), and grade 3 (smoking index \u0026gt;200).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis:\u003c/strong\u003e Data were analyzed using SPSS 21.0. Descriptive statistics, parametric or nonparametric tests, and chi-square tests were employed for comparisons. Spearman rank correlation assessed the relationship between smoking and CAS. Multivariate logistic regression evaluated associations between smoking and CAS.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cb\u003e1.Risk Factors Comparison\u003c/b\u003e: Among 1156 STEMI patients, 80 (6.9%) had CAS, with a higher prevalence of young adults and heavy smokers in the CAS group. The proportion of middle-aged and elderly patients, as well as those with diabetes and hypertension, was significantly lower in the CAS group (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Characteristics of CAS and Non-CAS Groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRisk Factor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCAS Group (n\u0026thinsp;=\u0026thinsp;80)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-CAS Group (n\u0026thinsp;=\u0026thinsp;1076)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge Groups, n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYoung Adults\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28 (35.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e148 (13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle-Aged\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e431 (40.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.652\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOld\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22 (27.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e497 (46.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70 (87.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e896 (83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.325\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e180 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCigarette Consumption, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e476 (44.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (11.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50 (62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e501 (46.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily History of Early CAD, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.563\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHypercholesterolemia, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e270 (25.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.076\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlcoholism, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54 (74.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e765 (77.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.487\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiabetes, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (17.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e373 (34.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHypertension, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (22.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e467 (43.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23.76\u0026thinsp;\u0026plusmn;\u0026thinsp;3.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.15\u0026thinsp;\u0026plusmn;\u0026thinsp;3.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.537\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eBMI: Body Mass Index.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e2.Age Group Comparison\u003c/b\u003e: Varying risk factors were observed among young adults (15.2%), middle-aged (39.9%), and elderly (44.9%) groups. Smoking, particularly heavy smoking, was more common in younger and middle-aged patients compared to the elderly (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of Risk Factors Among STEMI Patients in Different Age Groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRisk Factor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYoung Adults (n\u0026thinsp;=\u0026thinsp;176)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMiddle-Aged (n\u0026thinsp;=\u0026thinsp;461)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOld (n\u0026thinsp;=\u0026thinsp;519)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender, n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e171 (97.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e420 (91.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e375 (72.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e144 (27.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily History of Early CAD, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11 (6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlcoholism, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e61 (34.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e109 (23.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e71 (13.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOverweight, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e92 (52.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e185 (40.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e155 (29.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHypercholesterolemia, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53 (30.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e119 (25.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e111 (21.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiabetes, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41 (23.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e167 (36.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e178 (34.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHypertension, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49 (27.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e174 (37.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e262 (50.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCigarette Consumption, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38 (21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e160 (34.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e295 (56.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23 (13.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35 (19.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23 (5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e80 (45.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e270 (58.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e202 (38.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHeavy Smoking (Grades 2 and 3), n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e115 (65.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e293 (63.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e217 (41.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.05: Significant difference from the old group. P\u0026thinsp;\u0026lt;\u0026thinsp;0.01: Highly significant difference from the old group. + P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, ++ P\u0026thinsp;\u0026lt;\u0026thinsp;0.01 vs. the middle-aged group.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e3.Correlation Analysis\u003c/b\u003e: A positive correlation between cumulative cigarette consumption and CAS was found in all patients. Heavy smoking correlated with CAS in young adults and middle-aged patients, but not in the elderly (Tables\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation Between Smoking and Infarction-Related CAS in All Patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInfarction-Related CAS\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpearman rho-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.124**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSignificance (Two-Tailed Test)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1156\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*rho: Correlation coefficient; Sig.: p value; *: \u003cem\u003eSignificant correlation at p\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation Between Heavy Smoking (Grades 2 and 3) and Infarction-Related CAS in the Young Adult Group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeavy Smoking (Grades 2 and 3)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInfarction-Related CAS\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpearman rho-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.321**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSignificance (Two-Tailed Test)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e176\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*rho: Correlation coefficient; Sig.: p value; *: \u003cem\u003eSignificant correlation at p\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation Between Heavy Smoking (Grades 2 and 3) and Infarction-Related CAS in the Middle-Aged Group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeavy Smoking (Grades 2 and 3)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInfarction-Related CAS\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpearman rho-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.127**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSignificance (Two-Tailed Test)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e461\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*rho: Correlation coefficient; Sig.: p value; *: \u003cem\u003eSignificant correlation at p\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation Between Heavy Smoking (Grades 2 and 3) and Infarction-Related CAS in the Old Group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeavy Smoking (Grades 2 and 3)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInfarction-Related CAS\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpearman rho-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u0026thinsp;=\u0026thinsp;0.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSignificance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.724\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e519\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003erho: Correlation coefficient; Sig.: p value.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e4.Logistic Regression Analysis\u003c/b\u003e: Heavy smoking significantly increased the risk of CAS, with adjusted odds ratios of 6.397 for grade 2 smokers and 6.926 for grade 3 smokers compared to non-smokers. The risk of CAS was 4.912-fold higher in young adults and 2.041-fold higher in middle-aged patients compared to the elderly (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate Logistic Regression Analysis of Infarction-Related CAS\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eS.E.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWald χ\u0026sup2;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOR\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCigarette Consumption\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.801\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.902\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.628\u0026ndash;14.499\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.856\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.527\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.409\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6.397\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.278\u0026ndash;17.963\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.935\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.402\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6.926\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3.148\u0026ndash;15.239\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCigarette Consumption and Age\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 1 and the Young Adult Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.656\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.575\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.866\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.792\u0026ndash;10.375\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 1 and the Middle-Aged Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.096\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.297\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.366\u0026ndash;26.897\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrades 2 and 3 and the Young Adult Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.592\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.315\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.607\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.912\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.652\u0026ndash;9.100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrades 2 and 3 and the Middle-Aged Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.713\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.291\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.154\u0026ndash;3.609\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eOR: Odds Ratio; B: Partial Regression Coefficient; S.E.: Standard Error; a OR values are adjusted for diabetes mellitus, hypercholesterolemia, and hypertension. The analysis was performed using multivariate logistic regression with a stepwise entry method. The inclusion criteria for study factors were p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, and the exclusion criteria were p\u0026thinsp;\u0026lt;\u0026thinsp;0.10. Two-tailed p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/em\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cstrong\u003e1.Association Between Cumulative Cigarette Consumption and Infarction-Related Coronary Spasm (CAS) in STEMI Patients:\u003c/strong\u003eOur findings corroborate prior research indicating a significant positive correlation between cumulative cigarette consumption and infarction-related CAS in patients with ST-segment elevation myocardial infarction (STEMI). A controlled study by Xiang et al.\u0026nbsp;\u003csup\u003e7\u003c/sup\u003e involving 275 patients identified smoking as a critical risk factor for CAS, elevating the risk by a factor of 4.2. Our current data further affirm that the probability of CAS in STEMI patients is directly proportional to smoking intensity. Specifically, compared to non-smokers, the risk of infarction-related CAS is 6.397-fold higher among grade 2 smokers and 6.926-fold higher among grade 3 smokers. The underlying mechanism through which smoking contributes to CAS involves the activation of inflammatory pathways and the enhancement of oxidative stress\u0026nbsp;\u003csup\u003e11,12\u003c/sup\u003e. Additionally, smoking impairs endothelial nitric oxide (NO) production\u0026nbsp;\u003csup\u003e13\u003c/sup\u003e and directly damages endothelial cells, resulting in endothelial dysfunction\u003csup\u003e14\u003c/sup\u003e. Sugiishi et al.\u003csup\u003e15\u003c/sup\u003e\u0026nbsp; demonstrated that smoking induces a dose-dependent and potentially reversible impairment in endothelial-dependent vasodilation in young and middle-aged individuals, often without overt clinical symptoms. Consequently, smoking induces endothelial dysfunction, with more extensive smoking leading to greater endothelial damage and heightened susceptibility to CAS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.Impact of Heavy Smoking on Infarction-Related CAS in Young STEMI Patients\u003c/strong\u003e:Previous research by Xiang et al.\u0026nbsp;\u003csup\u003e7\u003c/sup\u003e has shown that CAS predominantly affects young men under the age of 35, with smoking identified as the principal risk factor. Notably, young males are more likely to be heavy smokers. Gulati et al.\u0026nbsp;\u003csup\u003e16\u003c/sup\u003ehave indicated that acute myocardial infarction (AMI) with normal coronary arteries can result from persistent CAS, with young heavy smokers being particularly vulnerable. Tolstrup et al.\u0026nbsp;\u003csup\u003e17,18\u003c/sup\u003e followed 4,326 patients with coronary heart disease and observed that the risk of coronary heart disease among smokers was highest in younger patients and lowest in older patients. The study by Imazio et al.\u0026nbsp;\u003csup\u003e18\u003c/sup\u003efurther found that smoking, dyslipidemia, and family history of coronary heart disease were significantly more prevalent among young and middle-aged AMI patients compared to older individuals, who more frequently exhibited diabetes and hypertension. Our study confirms that young and middle-aged STEMI patients exhibit high rates of smoking, which is positively correlated with CAS\u003csup\u003e19\u003c/sup\u003e. Furthermore, heavy smoking emerges as a major risk factor for STEMI-related CAS. Specifically, heavy smoking (grades 2 and 3) among young and middle-aged subjects is associated with a 4.912-fold and 2.041-fold increased risk of infarction-related CAS, respectively, compared to older patients. The susceptibility of young individuals to CAS may be attributed to a confluence of risk factors, primarily smoking and hyperlipidemia\u0026nbsp;\u003csup\u003e20\u003c/sup\u003e. Both smoking and hyperlipidemia independently elevate the risk of CAS by 3.2-fold and 1.3-fold, respectively\u003csup\u003e21\u003c/sup\u003e. In contrast, other risk factors such as hypertension and diabetes are more prevalent among middle-aged and older populations, and often present compounded risks when combined\u0026nbsp;\u003csup\u003e22\u003c/sup\u003e. Thus, smoking represents a substantial risk factor for infarction-related CAS in young STEMI patients.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights a significant positive correlation between cumulative cigarette consumption and infarction-related CAS in STEMI patients. Heavy smoking (grades 2 and 3) is identified as a major risk factor for CAS in young and middle-aged STEMI patients. Effective smoking cessation strategies are crucial for the prevention and management of STEMI, particularly targeting the young and middle-aged demographic in China.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e We acknowledge the dedicated efforts of all staff involved in implementing the intervention and evaluation components of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ Contributions:\u003c/strong\u003e Zhihui Kuang and Ranran Kong conceived and designed the study. Zhonghua Wang and Zhihui Kuang collected the data. Zhihui Kuang and Dingcheng Xiang analyzed the data. Dingcheng Xiang, Zhihui Kuang, and Lin Lin drafted the manuscript. Xianjun Mao and Lin Lin reviewed the manuscript. All authors read and approved the final draft.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This study was supported by the Medical Science and Technology Research Fund of Guangdong Province (No. 202311694435185) and the Science and Technology Project of Hunan Province (No. 2015JC3131).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials:\u003c/strong\u003e All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eThygesen, K. et al. Fourth Universal Definition of Myocardial Infarction (2018). Journal of the American College of Cardiology 72, 2231-2264, doi:10.1016/j.jacc.2018.08.1038 (2018).\u003c/li\u003e\n\u003cli\u003eMaseri, A. et al. Coronary vasospasm as a possible cause of myocardial infarction. A conclusion derived from the study of \u0026quot;preinfarction\u0026quot; angina. The New England journal of medicine 299, 1271-1277, doi:10.1056/nejm197812072992303 (1978).\u003c/li\u003e\n\u003cli\u003eWang, C. H., Kuo, L. T., Hung, M. J. \u0026amp; Cherng, W. J. Coronary vasospasm as a possible cause of elevated cardiac troponin I in patients with acute coronary syndrome and insignificant coronary artery disease. American heart journal 144, 275-281, doi:10.1067/mhj.2002.123843 (2002).\u003c/li\u003e\n\u003cli\u003eSueda, S. \u0026amp; Kohno, H. Impact of pharmacological spasm provocation test in patients with a history of syncope. Heart and vessels 33, 126-133, doi:10.1007/s00380-017-1046-8 (2018).\u003c/li\u003e\n\u003cli\u003eArslan, F. et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: comments from the Dutch ACS working group. Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation 26, 417-421, doi:10.1007/s12471-018-1134-0 (2018).\u003c/li\u003e\n\u003cli\u003eSucato, V., Comparato, F., Ortello, A. \u0026amp; Galassi, A. R. Myocardical Infarction with Non-Obstructive Coronary Arteries (MINOCA): pathogenesis, diagnosis and treatment. Current problems in cardiology 49, 102583, doi:10.1016/j.cpcardiol.2024.102583 (2024).\u003c/li\u003e\n\u003cli\u003eXiang, D. \u0026amp; Kleber, F. X. Smoking and hyperlipidemia are important risk factors for coronary artery spasm. Chinese medical journal 116, 510-513 (2003).\u003c/li\u003e\n\u003cli\u003eMorita, S. et al. Differences and interactions between risk factors for coronary spasm and atherosclerosis--smoking, aging, inflammation, and blood pressure. Internal medicine (Tokyo, Japan) 53, 2663-2670, doi:10.2169/internalmedicine.53.2705 (2014).\u003c/li\u003e\n\u003cli\u003eYasue, H., Mizuno, Y. \u0026amp; Harada, E. Coronary artery spasm - Clinical features, pathogenesis and treatment. Proceedings of the Japan Academy. Series B, Physical and biological sciences 95, 53-66, doi:10.2183/pjab.95.005 (2019).\u003c/li\u003e\n\u003cli\u003eGao, X., Zhang, Y., Breitling, L. P. \u0026amp; Brenner, H. Relationship of tobacco smoking and smoking-related DNA methylation with epigenetic age acceleration. Oncotarget 7, 46878-46889, doi:10.18632/oncotarget.9795 (2016).\u003c/li\u003e\n\u003cli\u003eKugiyama, K. et al. Nitric oxide-mediated flow-dependent dilation is impaired in coronary arteries in patients with coronary spastic angina. Journal of the American College of Cardiology 30, 920-926, doi:10.1016/s0735-1097(97)00236-2 (1997).\u003c/li\u003e\n\u003cli\u003eOda, M. et al. 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Orvosi hetilap 160, 1791-1797, doi:10.1556/650.2019.31555 (2019).\u003c/li\u003e\n\u003cli\u003eFalsoleiman, H., Bayani, B., Dehghani, M., Moohebati, M. \u0026amp; Rohani, A. Global coronary arteries spasm in a young patient. ARYA atherosclerosis 9, 260-262 (2013).\u003c/li\u003e\n\u003cli\u003eXiang，D, Zeng，D \u0026amp; Huo，Y. Diagnosis and treatment of coronary artery spasm syndrome,Consensus of Chinese experts. Chinese journal of interventional cardiology 23, 181-186., doi:10.3969/j.issn.1004-8812.2015.04.001 (2015).\u003c/li\u003e\n\u003cli\u003eGao，X \u0026amp; Yang，J. Analysis of cardiovascular risk factors in patients with acute myocardial infarction in China. Chinese circulation journal 30, 206-210, doi:CNKI:SUN:ZGGZ.0.2016-01-037 (2015). (2015).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cumulative cigarette consumption, Infarction-related coronary spasm, Acute myocardial infarction, ST-segment elevation, Coronary angiography","lastPublishedDoi":"10.21203/rs.3.rs-4933356/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4933356/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Coronary artery spasm (CAS) is a significant contributor to the pathogenesis of acute ST-elevation myocardial infarction (STEMI). Although smoking is a well-established risk factor for CAS, the relationship between cumulative cigarette consumption and infarction-related CAS across different age groups in STEMI patients remains unclear. This study aims to investigate how age modulates this correlation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods:\u003c/strong\u003e We conducted a retrospective study of STEMI patients who underwent coronary angiography (CAG) at the General Hospital of Southern Theater Command from December 2014 to March 2018. Inclusion criteria were: patients aged 18 years or older with confirmed STEMI and CAS. Exclusion criteria included absence of CAG, significant comorbidities, and incomplete data. Patients were categorized into CAS and non-CAS groups and further stratified by age into young adults (≤45 years), middle-aged (46-59 years), and elderly (≥60 years). Cumulative cigarette consumption was assessed using the smoking index. Statistical analyses evaluated correlations between smoking and CAS by age group.\u003c/p\u003e\n\u003cp\u003eThe approval for this study was obtained from the Ethics Committee of General Hospital of Southern Theater Command (2018-54). Since data were evaluated retrospectively, anonymously, and solely obtained for the study purposes, a requirement of informed consent was waived by General Hospital of Southern Theater Command ethics committee. All study methods were performed in accordance with Helsinki Declaration.\u003c/p\u003e\n\u003cp\u003eEthical approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThis study was approved by the ethics committee of General Hospital of Southern Theater Command (2018-54).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eOf 1156 STEMI patients, 80 (6.9%) had CAS. The CAS group had a higher prevalence of young adults (35% vs. 13.8%, P \u0026lt; 0.001) and heavy smokers (62.5% in CAS vs. 46.6% in non-CAS, P \u0026lt; 0.001). Heavy smoking correlated with CAS in young adults (r = 0.321, P \u0026lt; 0.001) and middle-aged patients (r = 0.127, P = 0.006), but not in the elderly. Logistic regression revealed that heavy smoking significantly increased the risk of CAS, with adjusted odds ratios of 6.397 for grade 2 smokers and 6.926 for grade 3 smokers compared to non-smokers. Among heavy smokers, the risk of CAS was 4.912 times higher in young adults and 2.041 times higher in middle-aged patients compared to the elderly.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Cumulative cigarette consumption is positively correlated with infarction-related CAS in STEMI patients. Heavy smoking is a major risk factor for CAS, especially in young and middle-aged individuals. Effective smoking control is essential for preventing and managing STEMI, particularly among younger and middle-aged populations in China.\u003c/p\u003e","manuscriptTitle":"The Correlation Between Cumulative Cigarette Consumption and Infarction-Related Coronary Spasm in Patients with ST-Segment Elevation Acute Myocardial Infarction Across Different Age Groups","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-24 05:26:19","doi":"10.21203/rs.3.rs-4933356/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-04T04:14:37+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-03T02:38:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-24T08:36:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"7343353368309201104919100914112112071","date":"2024-09-23T22:09:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"10817644522038243680125566206744521704","date":"2024-09-23T22:05:08+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-09-23T21:45:34+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-09-23T21:32:51+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-08-31T05:42:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-08-31T05:32:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-08-18T12:37:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8615e60d-f4df-491f-a077-d935434be411","owner":[],"postedDate":"September 24th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":38104585,"name":"Health sciences/Cardiology/Interventional cardiology"},{"id":38104586,"name":"Health sciences/Diseases/Cardiovascular diseases"}],"tags":[],"updatedAt":"2025-01-06T16:05:27+00:00","versionOfRecord":{"articleIdentity":"rs-4933356","link":"https://doi.org/10.1038/s41598-024-84125-5","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-01-02 15:57:34","publishedOnDateReadable":"January 2nd, 2025"},"versionCreatedAt":"2024-09-24 05:26:19","video":"","vorDoi":"10.1038/s41598-024-84125-5","vorDoiUrl":"https://doi.org/10.1038/s41598-024-84125-5","workflowStages":[]},"version":"v1","identity":"rs-4933356","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4933356","identity":"rs-4933356","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}