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Background: Smoking is a major public health problem and is a well-established risk factor for acute coronary syndrome (ACS). However, the patient characteristics and outcomes for smokers with ACS remained unclear in Taiwan.

Methods: ACS patients with known smoking status were analyzed from a Taiwan nationwide registry. We compared the current smokers and non-current smokers in terms of baseline demographics, clinical presentation, risk factors, medical treatment, and one-year outcomes.

Results: Of the 3128 patients, 1313 (42%) were current smokers. At baseline, current smokers were younger (56.9 ± 12.6 vs. 67.5 ± 12.4 years, p 》 0.0001), more obese (BMI: 25.9 ± 3.9 vs. 25.1 ± 3.8 kg/m^2, p 》 0.0001), and male predominant (95.4% vs. 65.2%, p 》 0.0001), but had a lower prevalence of hypertension (52.4% vs. 72.2%, p 》 0.0001), diabetes (27.7% vs. 41.9%, p 》 0.0001), and dyslipidemia (37.0% vs. 40.8%, p = 0.03). Additionally, the younger the age the lower the prevalence of hypertension and diabetes, but the higher prevalence to be current smokers (all p 》 0.0001). During hospitalization, antiplatelets, angiotensin converting enzyme inhibitors/angiotensin receptor blockers, and statins were more prescribed in smokers (all p 》 0.05). Over the course of a one year follow-up, cumulative all-cause mortality, recurrent myocardial infarction (re-infarction), and stroke (5.5% vs. 10.1%, p 》 0.0001) were lower in current smokers.

Conclusion: Smoking is associated with nearly 10 years earlier development of ACS in Taiwan. Younger ACS group had lower percentages of traditional cardiovascular risk factors but a higher percentage to be current smokers. Although smokers had better one-year outcomes, it may be attributed to younger age, fewer comorbidity, and more aggressive medical treatment.