Key result
Current smoking is linked to ~90% higher MACE risk vs never smoking, but past smoking is not.
Why the study?
Does current or past smoking increase the risk of MACE and CAD burden compared to never smoking in patients without known CAD undergoing CCTA?
Cohort (n=9,456)
Does current or past smoking increase the risk of MACE and CAD burden compared to never smoking in patients without known CAD undergoing CCTA?
While both current and past smokers have increased atherosclerotic burden compared to never smokers, only current smoking is associated with an increased risk of major adverse cardiac events.
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.
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Nakanishi et al. (2015) conducted a cohort in Patients without known coronary artery disease (n=9,456). Current smoking vs. Never smokers was evaluated on Major adverse cardiac events (all-cause death or non-fatal myocardial infarction) (HR 1.9, 95% CI 1.4-2.6, p=<0.001). Current smoking was associated with a higher risk of MACE compared with never smoking (HR 1.9; 95% CI 1.4-2.6; P<0.001), whereas past smoking was not.
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