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Cardiologia Croatica, Vol. 21 No. 1-2, 2026.

Meeting abstract

https://doi.org/10.15836/ccar2026.41

Cardiac functional recovery after acute coronary syndrome: a comparison between smokers and non-smokers

Ana Kovačević orcid id orcid.org/0000-0002-8909-9216 ; General Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia
Stjepan Kovačević orcid id orcid.org/0000-0002-7779-9805 ; General Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia
Iva Dumančić orcid id orcid.org/0009-0002-4123-0171 ; General Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia
Marijana Kovačević ; General Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia
Maja Franić orcid id orcid.org/0009-0003-3553-3229 ; General Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia
Josipa Meter orcid id orcid.org/0009-0009-9454-9785 ; General Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia
Nikolina Bukal orcid id orcid.org/0000-0002-7655-6078 ; General Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia
Ninoslav Leko orcid id orcid.org/0000-0002-2650-4405 ; General Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia
Katica Cvitkušić Lukenda orcid id orcid.org/0000-0001-6188-0708 ; General Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia

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Abstract

Keywords

acute coronary syndrome; smoking; cardiac functional recovery

Hrčak ID:

343424

URI

https://hrcak.srce.hr/343424

Publication date:

15.1.2026.

Visits: 194 *

Copyright statement: Croatian Cardiac Society

Copyright: 2025, Croatian Cardiac Society

Date received: 19 October 2025

Date: 14 November 2025

Publication date: December 2025

Publication date: December 2025

Volume: 21

Issue: 1-2

Pages: 41-42

Publisher ID: CC 2026 21_1-2_41-2

DOI: 10.15836/ccar2026.41

Article Information (continued)

Categories:

Subject: Extended Abstract

Categories:

Subject: Interdisciplinary approach to the patient with cardiovascular disease

KEYWORDS: :

KEYWORDS:

Keyword: acute coronary syndrome

Keyword: smoking

Keyword: cardiac functional recovery

Cardiac functional recovery after acute coronary syndrome: a comparison between smokers and non-smokers

[https://orcid.org/0000-0002-8909-9216] Ana Kovačević[1][*]

[https://orcid.org/0000-0002-7779-9805] Stjepan Kovačević[1]

[https://orcid.org/0009-0002-4123-0171] Iva Dumančić[1]

Marijana Kovačević[1]

[https://orcid.org/0009-0003-3553-3229] Maja Franić[1]

[https://orcid.org/0009-0009-9454-9785] Josipa Meter[1]

[https://orcid.org/0000-0002-7655-6078] Nikolina Bukal[1]

[https://orcid.org/0000-0002-2650-4405] Ninoslav Leko[1]

[https://orcid.org/0000-0001-6188-0708] Katica Cvitkušić Lukenda[1][2]

 

[1] General Hospital “Dr. Josip Benčević”, Slavonski Brod, Croatia

[2] Josip Juraj Strossmayer University of Osijek, Faculty of Dental Medicine and Health Osijek, Osijek, Croatia

Author notes:

Correspondence to: [*] ADDRESS 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.com

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.

TABLE 1 Baseline and clinical characteristics according to smoking status.
N (%)P*
SmokersNon-smokersTotal
Gender
Male13 (44.8)16 (55.2)29 (69)0.32
Female8 (61.5)5 (38.5)13 (31)
Coronary stenosis
Single-vessel disease10 (58.8)7 (41.2)17 (40.5)0.35
Multivessel disease11 (44)14 (56)25 (59.5)
Improved hypokinesia3 (37.5)5 (62.5)8 (19)0,7†
Improved diastolic dysfunction1 (33.3)2 (66.7)3 (7.1)>0.99†
Hyperlipidemia17 (53.1)15 (46.9)32 (76.2)0.5
Hypertension13 (46.4)15 (53.6)28 (66.7)0.51
Diabetes mellitus5 (83.3)1 (16.7)6 (14.3)0.18†
COPD2 (100)0 (0)2 (4.8)0.49†
*χ2 test; †Fisher’s exact test
TABLE 2 Comparison of cardiac recovery between smokers and non-smokers after acute coronary syndrome.
Median (IQR)P*
SmokersNon-smokers
LVEF (%)
Baseline value55 (45-62)57 (45-60)0.6
Follow-up value60 (52-62)60 (49-67)0.6
Left ventricle (cm)
Baseline value51 (45-53)52 (46-56)0.7
Follow-up value54 (46-56)52 (48-54)0.8
Left atrium (cm)
Baseline value42 (38-43)42 (36-45)>0.9
Follow-up value42 (38-43)39 (35-43)0.2
* Mann Whitney U test
FIGURE 1 Change in left ventricular ejection fraction (LVEF; %) over time (initial vs. follow-up) in smokers and non-smokers.
CC202621_1-2_41-2-f1
FIGURE 2 Change in left ventricular (LV) and left atrial (LA) dimensions (cm) over time (initial vs. follow-up) in smokers and non-smokers.
CC202621_1-2_41-2-f2

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.

LITERATURE

1 

Abusharekh M, Kampf J, Dykun I, Backmann V, Jánosi RA, Totzeck M, et al. Impact of smoking on procedural outcomes and all-cause mortality following acute myocardial infarction: A misleading early-stage pseudoparadox with ultimately reduced survival. Int J Cardiol Cardiovasc Risk Prev. 2024 September 27;23:200336. https://doi.org/10.1016/j.ijcrp.2024.200336 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/39403572

2 

Yoo JE, Jeong SM, Yeo Y, Jung W, Yoo J, Han K, et al. Smoking Cessation Reduces the Risk of Heart Failure: A Nationwide Cohort Study. JACC Heart Fail. 2023 March;11(3):277–87. https://doi.org/10.1016/j.jchf.2022.07.006 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/36647926

3 

Janjani P, Azimivaghar J, Salehi N, Haidari Moghadam R, Shakiba M, Siabani S, et al. Effect of Smoking Cessation on Left Ventricular Ejection Fraction after Acute ST Elevation Myocardial Infarction. ARYA Atheroscler. 2023 February;19(2):1–7. https://doi.org/10.48305/ARYA.2022.11895.2734 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/38883569

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