Key result
In patients with significant CAD on CTA, smoking was associated with an approximately four-fold higher annualized event rate for mortality or infarction compared with non-smokers (8.78% vs 2.07%).
Why the study?
Does smoking status influence the prognostic value of significant CAD detected by CTA in patients with suspected or known CAD?
Cohort (n=1,207)
Does smoking status influence the prognostic value of significant CAD detected by CTA in patients with suspected or known CAD?
Absolute Event Rate: 8.78% vs 2.07%
p-value: p=<0.05
Smoking significantly amplifies the risk of mortality and non-fatal infarction in patients with significant CAD detected on CTA, resulting in approximately four-fold higher event rates compared to non-smokers.
Smokers with significant CAD on CTCA show markedly higher event rates; extends prognostic stratification in observational cohorts but leaves causal effects of cessation open.
AIMS: Computed tomography coronary angiography (CTA) is an important non-invasive imaging modality increasingly used for the diagnosis and prognosis of coronary artery disease (CAD). The purpose of the current study was to determine the influence of smoking status on the prognostic value of CTA in patients with suspected or known CAD. METHODS AND RESULTS: In 1207 patients (57% male, age 57 ± 12 years) referred for CTA, the presence of significant CAD (≥ 50% stenosis) was determined. During follow-up (FU) the following events were recorded: all cause mortality, and non-fatal infarction. The prognostic value of CTA in smokers and non-smokers was compared using an interaction term in the Cox proportional hazard regression analysis. Significant CAD was observed in 327 patients (27%), and 273 patients (23%) were smokers. During a median FU time of 2.2 years, an event occurred in 50 patients. After correction for baseline characteristics including smoking in a multivariate model, significant CAD remained an independent predictor of events. Furthermore, a significant interaction (P < 0.05) was observed between significant CAD and smoking. The annualized event rate in smokers with significant CAD was 8.78% compared with 0.99% in smokers without significant CAD (P < 0.001). In non-smokers with significant CAD the annualized event rate was 2.07% compared with 1.01% in non-smokers without significant CAD (P= 0.058). CONCLUSION: The prognostic value of CTA was significantly influenced by smoking status. The event rates in patients with significant CAD were approximately four-fold higher in smokers compared with non-smokers. These findings suggest that smoking cessation needs to be aggressively pursued, especially in smokers with significant CAD.
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Werkhoven et al. (2010) conducted a cohort in suspected or known coronary artery disease (n=1,207). Smoking vs. Non-smokers was evaluated on all cause mortality and non-fatal infarction (p=<0.05). In patients with significant CAD on CTA, smoking was associated with an approximately four-fold higher annualized event rate for mortality or infarction compared with non-smokers (8.78% vs 2.07%).
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