Total life consumption of cigarettes as a determinant of coronary artery disease documented by coronary arteriography

The present study investigated the role of cigarette consumption as a clinical indicator of significant coronary artery disease, an application hitherto considered unrealistic. The study was done in two parts: (1) case control men (n=96) with coronary artery disease and men with normal coronary arteries of identical ages (n=96); (2) consecutive patients (n =1016−913 males and 103 females) subjected to diagnostic coronary arteriography and Bruce treadmill exercise testing. Significant coronary artery disease was defined as diameter stenosis ≥=70% for any coronary branch, except for left main stem ≥=50%. Exercise positivity was defined as ΔST ↓ ≥= 1 mm or ΔST ↑ ≥ 1 mm in leads without pathological Q waves. It was found that (1) patients with significant coronary artery disease were differentiated significantly (p < 0.001) from persons with normal coronary arteries by the life consumption of cigarettes (pack-years) independently of their age; (2) heavy smoking (>30 packyears) in male patients without a history of typical angina pectoris subjected to coronary arteriography is diagnostically equivalent to electrocardiographic positivity of exercise testing; (3) in the same context, smoking of any quantity in women is diagnostically equivalent to positive exercise testing. It was concluded that among patients addressed for diagnostic coronary arteriography and devoid of history of typical angina pectoris, smoking for women and heavy smoking for men is diagnostically equivalent to positive exercise testing.