Attenuated predictive power of a normal myocardial perfusion scan in young smokers |
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| Institution: | 1. Cardiology Department, Soroka University Medical Center, Beer-Sheva 84101, Israel;2. Clinical Research Center, Soroka University Medical Center, Beer-Sheva 84101, Israel;3. Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel;1. The Bruce and Ruth Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa, Israel;2. Heart Failure Unit, Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Lin Medical Center, Haifa, Israel;3. Heart Failure Clinic, Lin Medical Center, Haifa, Israel;4. Cardiovascular Department, Poriya Medical Center, Tiberius, Israel;1. Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, IRCCS Cà Granda Ospedale Maggiore Foundation, Milano, Italy;2. Center for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Italy;3. Department of Pharmacological Sciences and Biomolecular, University of Milan, Milan, Italy;4. IRCCS Multimedica, Milano, Italy;1. Department of Clinical Management of the Emergency Medicine Department, Hospital Universitario Central of Asturias, Group of Investigation in Emergency Medicine-HUCA, Oviedo, Spain;2. Department of Emergency Medicine and Short-Stay Unit, Hospital Clínico San Carlos, Madrid, Spain;3. Department of Emergency Medicine, Hospital Universitaride Bellvitge, Barcelona, Spain;4. Department of Management of Geriatric Care, Hospital Monte Naranco, Oviedo, Spain;5. Department of Emergency Medicine-Short-Stay Unit and Home Hospitalization, Hospital Universitario General de Alicante, Alicante, Spain;6. Department of Emergency Medicine, Hospital Clinic, IDIBAPS, Barcelona, Spain;7. Department of Emergency Medicine, Hospital La Fe, Valencia, Spain;1. Aix-Marseille University, Department of Internal Medicine, Hôpital de la Conception, AP-HM, Marseille, France;2. Aix Marseille Université, Inserm, IRD, UMR_S912, SESSTIM, Marseille, France;3. APHM, Department of Public Health, BiosTIC, Hôpital de la Timone, Marseille, France;4. Department of Internal Medicine, HEGP, Paris, France |
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| Abstract: | BackgroundThe negative predictive value of a normal myocardial perfusion image (MPI) for myocardial infarction or cardiac death is very high. However, it is unclear whether a normal MPI, reflecting non-compromised blood flow in the stable state, would have the same prognostic implications in smokers as in patients who do not smoke.MethodsThe incidence of total mortality, cardiovascular mortality, and myocardial infarction was evaluated in 11,812 subjects (14.6% of whom were current smokers at the time of the study) with a normal MPI study and no past history of coronary artery disease during the period 1997 to 2008.ResultsDuring an average follow-up of 72.4 ± 32.4 months the risk for an acute myocardial infarction in current smokers was approximately 50% higher than the corresponding risk in non-smokers, despite a younger average age. Cox proportional regression models show that current smoking was associated with an increased hazard rate for the composite endpoint below age 60 (HR = 2.09, 95%CI 1.43–3.07, p < 0.001), but not at older ages (HR = 1.16, 95% CI 0.81–1.66, p = 0.4).ConclusionsIn individuals below age 60, but not at older ages, current smoking is associated with increased short- and long-term risk of cardiac death and acute myocardial infarction even in subjects with a normal MPI. |
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