Influence of smoking on the prognostic value of cardiovascular computed tomography coronary angiography.
OBJECTIVE
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.


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).


CONCLUSIONS
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.
Department of Cardiology, Leiden University Medical Center, ZA Leiden, The Netherlands.
Jacob M
JM
van Werkhoven
Joanne D
JD
Schuijf
Aju P
AP
Pazhenkottil
Bernard A
BA
Herzog
Jelena R
JR
Ghadri
J Wouter
JW
Jukema
Eric
E
Boersma
Lucia J
LJ
Kroft
Albert
A
de Roos
Philipp A
PA
Kaufmann
Jeroen J
JJ
Bax
D000368:Aged; D017023:Coronary Angiography / Q000401:mortality*; D003324:Coronary Artery Disease / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D012907:Smoking / Q000401:mortality*; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000401:mortality*