Current but not past smoking increases the risk of cardiac events: Insights from coronary computed tomographic angiography

Rine Nakanishi, Daniel S. Berman, Matthew J. Budoff, Heidi Gransar, Stephan Achenbach, Mouaz Al-Mallah, Daniele Andreini, Filippo Cademartiri, Tracy Q. Callister, Hyuk Jae Chang, Victor Y. Cheng, Kavitha Chinnaiyan, Benjamin J.W. Chow, Ricardo Cury, Augustin Delago, Martin Hadamitzky, Jörg Hausleiter, Gudrun Feuchtner, Yong Jin Kim, Philipp A. KaufmannJonathon Leipsic, Fay Y. Lin, Erica Maffei, Gianluca Pontone, Gilbert Raff, Leslee J. Shaw, Todd C. Villines, Allison Dunning, James K. Min

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


Aims We evaluated coronary artery disease (CAD) extent, severity, and major adverse cardiac events (MACEs) in never, past, and current smokers undergoing coronary CT angiography (CCTA). Methods and results We evaluated 9456 patients (57.1 ± 12.3 years, 55.5% male) without known CAD (1588 current smokers; 2183 past smokers who quit ≥ 3 months before CCTA; and 5685 never smokers). By risk-adjusted Cox proportional-hazards models, we related smoking status to MACE (all-cause death or non-fatal myocardial infarction). We further performed 1:1:1 propensity matching for 1000 in each group evaluate event risk among individuals with similar age, gender, CAD risk factors, and symptom presentation. During a mean follow-up of 2.8 ± 1.9 years, 297 MACE occurred. Compared with never smokers, current and past smokers had greater atherosclerotic burden including extent of plaque defined as segments with any plaque (2.1 ± 2.8 vs. 2.6 ± 3.2 vs. 3.1 ± 3.3, P < 0.0001) and prevalence of obstructive CAD [1-vessel disease (VD): 10.6% vs. 14.9% vs. 15.2%, P < 0.001; 2-VD: 4.4% vs. 6.1% vs. 6.2%, P = 0.001; 3-VD: 3.1% vs. 5.2% vs. 4.3%, P < 0.001]. Compared with never smokers, current smokers experienced higher MACE risk [hazard ratio (HR) 1.9, 95% confidence interval (CI) 1.4-2.6, P < 0.001], while past smokers did not (HR 1.2, 95% CI 0.8-1.6, P = 0.35). Among matched individuals, current smokers had higher MACE risk (HR 2.6, 95% CI 1.6-4.2, P < 0.001), while past smokers did not (HR 1.3, 95% CI 0.7-2.4, P = 0.39). Similar findings were observed for risk of all-cause death. Conclusion Among patients without known CAD undergoing CCTA, current and past smokers had increased burden of atherosclerosis compared with never smokers; however, risk of MACE was heightened only in current smokers.

Original languageEnglish (US)
Pages (from-to)1031-1040
Number of pages10
JournalEuropean heart journal
Issue number17
StatePublished - May 1 2015


  • Coronary atherosclerosis
  • Coronary computed tomographic angiography
  • Major adverse cardiovascular risk
  • Smoking risk

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Current but not past smoking increases the risk of cardiac events: Insights from coronary computed tomographic angiography'. Together they form a unique fingerprint.

Cite this