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

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Publication date 2011
Author van Werkhoven Jacob M, Schuijf Joanne D, Pazhenkottil Aju P, Herzog Bernard A, Ghadri Jelena R, Jukema J Wouter, Boersma Eric, Kroft Lucia J, de Roos Albert, Kaufmann Philipp A, Bax Jeroen J,
Project Entwicklung einer neuen Hybrid-Bildgebungs-Methode zur nicht invasiven kardialen Diagnostik
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Original article (peer-reviewed)

Journal European heart journal
Volume (Issue) 32(3)
Page(s) 365 - 70
Title of proceedings European heart journal
DOI 10.1093/eurheartj/ehq441


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.