Rine Nakanishi1, Daniel S Berman2, Matthew J Budoff1, Heidi Gransar2, Stephan Achenbach3, Mouaz Al-Mallah4, Daniele Andreini5, Filippo Cademartiri6, Tracy Q Callister7, Hyuk-Jae Chang8, Victor Y Cheng9, Kavitha Chinnaiyan10, Benjamin J W Chow11, Ricardo Cury12, Augustin Delago13, Martin Hadamitzky14, Jörg Hausleiter14, Gudrun Feuchtner15, Yong-Jin Kim16, Philipp A Kaufmann17, Jonathon Leipsic18, Fay Y Lin19, Erica Maffei6, Gianluca Pontone5, Gilbert Raff10, Leslee J Shaw20, Todd C Villines21, Allison Dunning22, James K Min23. 1. Department of Medicine, Harbor UCLA Medical Center, Torrance, CA, USA. 2. Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA. 3. Department of Medicine, University of Erlangen, Erlangen, Germany. 4. Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI, USA. 5. Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy. 6. Cardio Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Italy Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands. 7. Tennessee Heart and Vascular Institute, Hendersonville, TN, USA. 8. Division of Cardiology, Severance Cardiovascular Hospital, Seoul, Republic of Korea. 9. Oklahoma Heart Institute, Tulsa, OK, USA. 10. William Beaumont Hospital, Royal Oaks, MI, USA. 11. Department of Medicine and Radiology, University of Ottawa, Ottawa, ON, Canada. 12. Baptist Cardiac and Vascular Institute, Miami, FL, USA. 13. Capitol Cardiology Associates, Albany, NY, USA. 14. Division of Cardiology, DeutschesHerzzentrumMünchen, Munich, Germany. 15. Department of Radiology, Medical University of Innsbruck, Innsbuck, Austria. 16. Department of Medicine and Radiology, Seoul National University Hospital, Seoul, South Korea. 17. Department of Nuclear Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland. 18. Department of Medical Imaging and Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, USA. 19. Department of Radiology, Weill Cornell Medical College and the New York Presbyterian Hospital, New York, NY, USA. 20. Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA. 21. Department of Medicine, Walter Reed National Medical Center, Bethesda, MD, USA. 22. Department of Public Health, Weill Cornell Medical College and the New York Presbyterian Hospital, New York, NY, USA. 23. Department of Radiology, Weill Cornell Medical College and the New York Presbyterian Hospital, New York, NY, USA jkm2001@med.cornell.edu runone123@gmail.com.
Abstract
AIMS: We evaluated coronary artery disease (CAD) extent, severity, and major adverse cardiac events (MACEs) in never, past, and current smokers undergoing coronary CT angiography (CCTA). METHODS AND RESULTS: We evaluated 9456 patients (57.1 ± 12.3 years, 55.5% male) without known CAD (1588 current smokers; 2183 past smokers who quit ≥3 months before CCTA; and 5685 never smokers). By risk-adjusted Cox proportional-hazards models, we related smoking status to MACE (all-cause death or non-fatal myocardial infarction). We further performed 1:1:1 propensity matching for 1000 in each group evaluate event risk among individuals with similar age, gender, CAD risk factors, and symptom presentation. During a mean follow-up of 2.8 ± 1.9 years, 297 MACE occurred. Compared with never smokers, current and past smokers had greater atherosclerotic burden including extent of plaque defined as segments with any plaque (2.1 ± 2.8 vs. 2.6 ± 3.2 vs. 3.1 ± 3.3, P < 0.0001) and prevalence of obstructive CAD [1-vessel disease (VD): 10.6% vs. 14.9% vs. 15.2%, P < 0.001; 2-VD: 4.4% vs. 6.1% vs. 6.2%, P = 0.001; 3-VD: 3.1% vs. 5.2% vs. 4.3%, P < 0.001]. Compared with never smokers, current smokers experienced higher MACE risk [hazard ratio (HR) 1.9, 95% confidence interval (CI) 1.4-2.6, P < 0.001], while past smokers did not (HR 1.2, 95% CI 0.8-1.6, P = 0.35). Among matched individuals, current smokers had higher MACE risk (HR 2.6, 95% CI 1.6-4.2, P < 0.001), while past smokers did not (HR 1.3, 95% CI 0.7-2.4, P = 0.39). Similar findings were observed for risk of all-cause death. CONCLUSION: Among patients without known CAD undergoing CCTA, current and past smokers had increased burden of atherosclerosis compared with never smokers; however, risk of MACE was heightened only in current smokers. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: We evaluated coronary artery disease (CAD) extent, severity, and major adverse cardiac events (MACEs) in never, past, and current smokers undergoing coronary CT angiography (CCTA). METHODS AND RESULTS: We evaluated 9456 patients (57.1 ± 12.3 years, 55.5% male) without known CAD (1588 current smokers; 2183 past smokers who quit ≥3 months before CCTA; and 5685 never smokers). By risk-adjusted Cox proportional-hazards models, we related smoking status to MACE (all-cause death or non-fatal myocardial infarction). We further performed 1:1:1 propensity matching for 1000 in each group evaluate event risk among individuals with similar age, gender, CAD risk factors, and symptom presentation. During a mean follow-up of 2.8 ± 1.9 years, 297 MACE occurred. Compared with never smokers, current and past smokers had greater atherosclerotic burden including extent of plaque defined as segments with any plaque (2.1 ± 2.8 vs. 2.6 ± 3.2 vs. 3.1 ± 3.3, P < 0.0001) and prevalence of obstructive CAD [1-vessel disease (VD): 10.6% vs. 14.9% vs. 15.2%, P < 0.001; 2-VD: 4.4% vs. 6.1% vs. 6.2%, P = 0.001; 3-VD: 3.1% vs. 5.2% vs. 4.3%, P < 0.001]. Compared with never smokers, current smokers experienced higher MACE risk [hazard ratio (HR) 1.9, 95% confidence interval (CI) 1.4-2.6, P < 0.001], while past smokers did not (HR 1.2, 95% CI 0.8-1.6, P = 0.35). Among matched individuals, current smokers had higher MACE risk (HR 2.6, 95% CI 1.6-4.2, P < 0.001), while past smokers did not (HR 1.3, 95% CI 0.7-2.4, P = 0.39). Similar findings were observed for risk of all-cause death. CONCLUSION: Among patients without known CAD undergoing CCTA, current and past smokers had increased burden of atherosclerosis compared with never smokers; however, risk of MACE was heightened only in current smokers. Published on behalf of the European Society of Cardiology. All rights reserved.
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