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SMOKING AND ITS RELATIONSHIP WITH LONG TERM EVENTS: FURTHER INSIGHTS FROM THE CONFIRM (CORONARY CT ANGIOGRAPHY EVALUATION FOR CLINICAL OUTCOMES: AN INTERNATIONAL MULTICENTER) REGISTRY
1593 JACC March 21, 2017 Volume 69, Issue 11
Non Invasive Imaging (Echocardiography, Nuclear, PET, MR and CT) SMOKING AND ITS RELATIONSHIP WITH LONG TERM EVENTS: FURTHER INSIGHTS FROM THE CONFIRM (CORONARY CT ANGIOGRAPHY EVALUATION FOR CLINICAL OUTCOMES: AN INTERNATIONAL MULTICENTER) REGISTRY Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m. Session Title: Non Invasive Imaging: Prognostic Implications of CT Angiography Abstract Category: 27. Non Invasive Imaging: CT/Multimodality, Angiography, and Non-CT Angiography Presentation Number: 1247-228 Authors: Nima Omid-Fard, Amir Ahmadi, Philipp Blanke, Stephanie Sellers, Heidi Gransar, Daniel Berman, Tracy Callister, Augustin DeLago, Martin Hadamitzky, Joerg Hausleiter, Matthew Budoff, Philipp Kaufmann, Gilbert Raff, Kavitha Chinnaiyan, Todd Villines, Gudrun Feuchtner, Gianluca Pontone, Daniele Andreini, Hugo Marques, Ronen Rubinshtein, Stephan Achenbach, Leslee Shaw, Millie Gomez, James Min, Jonathon Leipsic, Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada Background: In recent past, the CONFIRM registry documented a non-significant increase in major adverse cardiac events (MACE) among past versus never smokers, a finding which likely owed to the relatively brief follow-up duration. This analysis sought to determine the long-term predictive value of coronary computed tomography angiography (CCTA) in never, past, and current smokers when subset by coronary artery disease (CAD) severity and extent. Further, we aimed to ascertain whether active smoking confers incremental risk of MACE (all-cause mortality (ACM) and acute coronary syndrome) and ACM as compared with propensity matched historical and never smokers. Methods: From the registry, 3,116 patients (mean age 60.2±11.7 years, 61.1 % male) whose smoking information was known and who had a minimum of 5 years clinical follow up post CCTA were examined. Patients were classified as: never smokers (2,052, 65.85%), past smokers (402, 12.90%), defined as those who quit smoking ≥3 months prior to CCTA, and current smokers (662, 21.25%), who currently smoke or quit <3 months prior to CCTA. We then performed propensity matching on a 1:1:1 basis (314 per group) for age, sex, hypertension, diabetes, dyslipidemia, family history, plaque burden, stenosis severity, and cardiovascular symptoms. Logistic regression estimated hazard ratios for current and past smokers compared with never smokers.
Results: Both past (HR 1.52 [1.11-2.09]) and current (HR 1.53 [1.17-2.01]) smokers had an increased risk of MACE in the non-matched cohort, as compared with never smokers. ACM was increased only for current (HR 1.60 [1.13-2.29]) but not past smokers (HR 1.46 [0.972.21]). After matching, past (HR 2.03 [1.21-3.40]) and current (1.96 [1.17-3.28]) smokers were at a heightened risk of MACE. The latter relationship was also apparent for ACM among past (HR- 2.54 [1.26-5.09]) and current (HR- 2.25 [1.12-4.50]) smokers. Conclusions: In previous shorter-term follow up, smoking cessation showed a return to similar risk as never smokers. However, our analysis indicates that at 5 year follow up, when matched for baseline risk and even the extent and severity of CAD, past smokers exhibit similar risk to active smokers.
Non Invasive Imaging (Echocardiography, Nuclear, PET, MR and CT) SMOKING AND ITS RELATIONSHIP WITH LONG TERM EVENTS: FURTHER INSIGHTS FROM THE CONFIRM (CORONARY CT ANGIOGRAPHY EVALUATION FOR CLINICAL OUTCOMES: AN INTERNATIONAL MULTICENTER) REGISTRY Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m. Session Title: Non Invasive Imaging: Prognostic Implications of CT Angiography Abstract Category: 27. Non Invasive Imaging: CT/Multimodality, Angiography, and Non-CT Angiography Presentation Number: 1247-228 Authors: Nima Omid-Fard, Amir Ahmadi, Philipp Blanke, Stephanie Sellers, Heidi Gransar, Daniel Berman, Tracy Callister, Augustin DeLago, Martin Hadamitzky, Joerg Hausleiter, Matthew Budoff, Philipp Kaufmann, Gilbert Raff, Kavitha Chinnaiyan, Todd Villines, Gudrun Feuchtner, Gianluca Pontone, Daniele Andreini, Hugo Marques, Ronen Rubinshtein, Stephan Achenbach, Leslee Shaw, Millie Gomez, James Min, Jonathon Leipsic, Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada Background: In recent past, the CONFIRM registry documented a non-significant increase in major adverse cardiac events (MACE) among past versus never smokers, a finding which likely owed to the relatively brief follow-up duration. This analysis sought to determine the long-term predictive value of coronary computed tomography angiography (CCTA) in never, past, and current smokers when subset by coronary artery disease (CAD) severity and extent. Further, we aimed to ascertain whether active smoking confers incremental risk of MACE (all-cause mortality (ACM) and acute coronary syndrome) and ACM as compared with propensity matched historical and never smokers. Methods: From the registry, 3,116 patients (mean age 60.2±11.7 years, 61.1 % male) whose smoking information was known and who had a minimum of 5 years clinical follow up post CCTA were examined. Patients were classified as: never smokers (2,052, 65.85%), past smokers (402, 12.90%), defined as those who quit smoking ≥3 months prior to CCTA, and current smokers (662, 21.25%), who currently smoke or quit <3 months prior to CCTA. We then performed propensity matching on a 1:1:1 basis (314 per group) for age, sex, hypertension, diabetes, dyslipidemia, family history, plaque burden, stenosis severity, and cardiovascular symptoms. Logistic regression estimated hazard ratios for current and past smokers compared with never smokers.
Results: Both past (HR 1.52 [1.11-2.09]) and current (HR 1.53 [1.17-2.01]) smokers had an increased risk of MACE in the non-matched cohort, as compared with never smokers. ACM was increased only for current (HR 1.60 [1.13-2.29]) but not past smokers (HR 1.46 [0.972.21]). After matching, past (HR 2.03 [1.21-3.40]) and current (1.96 [1.17-3.28]) smokers were at a heightened risk of MACE. The latter relationship was also apparent for ACM among past (HR- 2.54 [1.26-5.09]) and current (HR- 2.25 [1.12-4.50]) smokers. Conclusions: In previous shorter-term follow up, smoking cessation showed a return to similar risk as never smokers. However, our analysis indicates that at 5 year follow up, when matched for baseline risk and even the extent and severity of CAD, past smokers exhibit similar risk to active smokers.