***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Treatment with angiotensin-converting-enzyme ( ACE ) inhibitors reduces mortality among survivors of acute myocardial infa rct ion , but whether to use ACE inhibitors in all patients or only in selected patients is uncertain . METHODS We screened 6676 consecutive patients with 7001 myocardial infa rct ions confirmed by enzyme studies . A total of 2606 patients had echocardiographic evidence of left ventricular systolic dysfunction ( ejection fraction , < or = 35 percent ) . On days 3 to 7 after infa rct ion , 1749 patients were r and omly assigned to receive oral tr and olapril ( 876 patients ) or placebo ( 873 patients ) . The duration of follow-up was 24 to 50 months . RESULTS During the study period , 304 patients ( 34.7 percent ) in the tr and olapril group died , as compared with 369 ( 42.3 percent ) in the placebo group ( P = 0.001 ) . The relative risk of death in the tr and olapril group , as compared with the placebo group , was 0.78 ( 95 percent confidence interval , 0.67 to 0.91 ) . Tr and olapril also reduced the risk of death from cardiovascular causes ( relative risk , 0.75 ; 95 percent confidence interval , 0.63 to 0.89 ; P = 0.001 ) and sudden death ( relative risk , 0.76 ; 95 percent confidence interval , 0.59 to 0.98 ; P = 0.03 ) . Progression to severe heart failure was less frequent in the tr and olapril group ( relative risk , 0.71 ; 95 percent confidence interval , 0.56 to 0.89 ; P = 0.003 ) . In contrast , the risk of recurrent myocardial infa rct ion ( fatal or nonfatal ) was not significantly reduced ( relative risk , 0.86 ; 95 percent confidence interval , 0.66 to 1.13 ; P = 0.29 ) . CONCLUSIONS Long-term treatment with tr and olapril in patients with reduced left ventricular function soon after myocardial infa rct ion significantly reduced the risk of overall mortality , mortality from cardiovascular causes , sudden death , and the development of severe heart failure . That mortality was reduced in a r and omized study enrolling 25 percent of consecutive patients screened should encourage the selective use of ACE inhibition after myocardial infa rct ion Background The aim of the present study was to investigate whether a previously shown survival benefit result ing from routine early invasive management of unselected patients with acute non-ST-segment elevation myocardial infa rct ion ( NSTEMI ) may differ according to smoking status and age . Methods Post-hoc analysis of a prospect i ve observational cohort study of consecutive patients admitted for NSTEMI in 2003 ( conservative strategy cohort [ CS ] ; n = 185 ) and 2006 ( invasive strategy cohort [ IS ] ; n = 200 ) . A strategy for transfer to a high-volume invasive center and routine early invasive management was implemented in 2005 . Patients were subdivided into current smokers and non-smokers ( including ex-smokers ) on admission . Results The one-year mortality rate of smokers was reduced from 37 % in the CS to 6 % in the IS ( p < 0.001 ) , and from 30 % to 23 % for non-smokers ( p = 0.18 ) . Non-smokers were considerably older than smokers ( median age 80 vs. 63 years , p < 0.001 ) . The percentage of smokers who underwent revascularization ( angioplasty or coronary artery bypass grafting ) within 7 days increased from 9 % in the CS to 53 % in the IS ( p < 0.001 ) . The corresponding numbers for non-smokers were 5 % and 27 % ( p < 0.001 ) . There was no interaction between strategy and age ( p = 0.25 ) , as opposed to a significant interaction between strategy and smoking status ( p = 0.024 ) . Current smoking was an independent predictor of one-year mortality ( hazard ratio 2.61 , 95 % confidence interval 1.43 - 4.79 , p = 0.002 ) . Conclusions The treatment effect of an early invasive strategy in unselected patients with NSTEMI was more pronounced among smokers than non-smokers . The benefit for smokers was not entirely explained by differences in baseline confounders , such as their younger age OBJECTIVES This study sought to compare the relation between smoking and the 30-day and 6-month outcome after acute myocardial infa rct ion in an Israeli nationwide survey . BACKGROUND Studies before and during the thrombolytic era reported similar or lower early mortality after acute myocardial infa rct ion in smokers than in nonsmokers . This finding is intriguing and may be misleading because numerous epidemiologic studies have clearly shown that smoking is an independent risk factor for atherosclerosis , myocardial infa rct ion and death . METHODS The study cohort comprised 999 consecutive patients with an acute myocardial infa rct ion from a prospect i ve nationwide survey conducted during January and February 1994 in all coronary care units operating in Israel . The prognosis of 367 patients ( 37 % ) who were smokers ( current smokers and those who smoked up to 1 month before admission ) was compared with that of 632 nonsmokers ( past smokers or those who never smoked ) . RESULTS Smokers were on average 10 years younger and were more frequently men and patients with a family history of coronary heart disease and inferior infa rct ion and less frequently patients with a previous infa rct ion or a history of angina , hypertension and diabetes than nonsmokers . Smokers also had a lower incidence of congestive heart failure on admission or during the hospital period . Thrombolytic therapy ( 49 % vs. 40 % , p < 0.01 ) and aspirin ( 89 % vs. 80 % , p < 0.001 ) were administered more frequently in smokers than nonsmokers . The crude 30-day ( 6.0 % vs. 15.7 % ) and cumulative 6-month ( 7.9 % vs. 21.5 % ) mortality rates were significantly lower ( p < 0.0001 for both ) in smokers than nonsmokers , respectively . However , after adjustment for age , baseline characteristics , thrombolytic therapy and invasive coronary procedures , the lower 30-day ( odds ratio [ OR ] 0.75 , 95 % confidence interval [ CI ] 0.43 to 1.29 , p = 0.30 ) and 6-month ( hazard ratio 0.84 , 95 % CI 0.54 to 1.30 , p = 0.42 ) mortality rates in smokers and nonsmokers were not significantly different . The model had a power of 0.80 for OR 0.50 , with alpha 0.1 . CONCLUSIONS In our nationwide survey , the seemingly better prognosis of smokers early after acute myocardial infa rct ion was no longer evident after adjustment for baseline and clinical variables and may be explained by their younger age and a more favorable risk profile . Smokers develop acute myocardial infa rct ion a decade earlier than nonsmokers . Efforts to lower the prevalence of smoking should continue OBJECTIVES Our purpose was to evaluate the relation between smoking and the outcomes of patients receiving thrombolysis for acute myocardial infa rct ion . BACKGROUND A paradoxic beneficial effect has been observed in smokers with a myocardial infa rct ion . We analyzed outcomes and baseline characteristics of 11,975 nonsmokers , 11,117 ex-smokers and 17,507 current smokers in a multinational trial of thrombolysis for acute myocardial infa rct ion . METHODS Patients were r and omized to one of four thrombolytic protocol s.  An angiographic sub study in 2,431 patients evaluated reperfusion , reocclusion and ventricular function . Effects of smoking were evaluated by logistic regression analysis after adjustment for age and gender . A mortality model evaluated the simultaneous effect of baseline characteristics on the prognostic importance of smoking . These processes were performed with data from both the main trial and the angiographic sub study ; then angiographic factors ( coronary anatomy , patency and ejection fraction ) were added to the model . RESULTS Smokers were significantly younger by a mean of 11 years ) and had less comorbidity or severe coronary artery disease than nonsmokers . Nonsmokers had significantly higher hospital and 30-day mortality rates ( 9.9 % and 10.3 % , respectively ) than smokers ( 3.7 % vs. 4 % , respectively , both p < 0.001 ) and more in-hospital complications . The unadjusted odds ratio for 30-day mortality in nonsmokers was 3.36 ( 95 % confidence interval [ CI ] 2.08 to 5.41 ) , 1.21 ( 95 % CI 0.71 to 2.08 ) after adjustment for age and gender and 1.08 ( 95 % CI 0.59 to 1.96 ) after adjustment for all clinical baseline characteristics . CONCLUSIONS Smokers receiving thrombolysis for acute myocardial infa rct ion presented 11 years earlier than nonsmokers , which generally accounted for their better outcome . When other differences in clinical and angiographic baseline factors and therapeutic responses were evaluated , no significant difference in mortality was seen between smokers and nonsmokers BACKGROUND Despite advances in pharmacologic therapy and invasive management strategies for patients with non-ST-segment elevation acute coronary syndromes ( NSTE ACS ) , these patients still suffer substantial morbidity and mortality . OBJECTIVE The objective of this study was to analyze independent predictors of 1-year mortality in patients with high-risk NSTE ACS . DESIGN AND PARTICIPANTS A total of 9,978 patients were assigned to receive enoxaparin or unfractionated heparin ( UFH ) in this prospect i ve , r and omized , open-label , international trial . MEASUREMENTS Vital status at 1 year was collected . Univariable and multivariable predictors of 1-year mortality were identified . Three different multivariable regression models were constructed to identify : ( 1 ) predictors of 30-day mortality ; ( 2 ) predictors of 1-year mortality ; ( 3 ) predictors of 1-year mortality in 30-day survivors . The last model is the focus of this paper . RESULTS Overall , 9,922 ( 99.4 % ) of patients had 1-year follow-up . Of the 56 patients ( 37  UFH-assigned  and 19 enoxaparin-assigned ) without 1-year data , 11 patients were excluded because of withdrawal of consent , and 45 could not be located . One-year mortality was 7.5 % ( 7.7 % enoxaparin-assigned patients ; 7.3 % UFH-assigned patients ; P = 0.4 ) . In patients surviving 30 days after enrollment , independent predictors of 1-year mortality included factors known at baseline such as increased age , male sex , decreased weight , having ever smoked , decreased creatinine clearance , ST-segment depression , history of diabetes , history of angina , congestive heart failure , coronary artery bypass grafting , increased heart rate , rales , increased hematocrit , lowered hemoglobin , and higher platelet count . Factors predictive of mortality during the hospitalization and 30-day follow-up period were decreased weight at 30 days from baseline , atrial fibrillation , decreased nadir platelet , no use of beta-blockers and statins up to 30 days , and not receiving an intervention ( c-index = 0.82 ) . CONCLUSIONS Easily determined baseline clinical characteristics can be used to predict 1-year mortality with reasonable discriminative power . These models corroborate prior work in a contemporary aggressively managed population . A model to predict 1-year mortality in patients surviving at least 30 days may be quite helpful to healthcare providers in setting expectations and goals with patients after ACS BACKGROUND Smoking is known to be a strong risk factor for premature atherosclerosis , myocardial infa rct ion , and sudden cardiac death . Unexpectedly , in the reperfusion era , investigators have reported that patients who smoke have a more favorable prognosis after thrombolysis compared with non-smokers . Since smoking is associated with a relatively hyper-coagulable state , we hypothesized that the coronary occlusion responsible for infa rct ion may be primarily thrombotic , with improved outcome relating to enhanced patency or the absence of a residual stenosis after thrombolytic therapy . METHODS AND RESULTS To examine this issue , we evaluated 1619 patients treated with TPA , urokinase , or both in six consecutive myocardial infa rct ion trials , of whom 878 ( 54 % ) were currently smoking . Patients underwent 90-minute and predischarge catheterizations , which were quantified blinded to the patients ' 
    Output:
    
Conclusion The " smoker 's paradox " was observed in some studies of AMI patients in the pre-thrombolytic and thrombolytic era , whereas no studies of a contemporary population with acute coronary syndrome have found evidence for such a paradox