Impact of Smoking on Coronary Volume–to–Myocardial Mass Ratio: An ADVANCE Registry Substudy

Kenneth R. Holmes, Gaurav S. Gulsin, Timothy A. Fairbairn, Lynne Hurwitz-Koweek, Hitoshi Matsuo, Bjarne L. Nørgaard, Jesper M. Jensen, Niels Peter Rønnow Sand, Koen Nieman, Jeroen J. Bax, Gianluca Pontone, Kavitha M. Chinnaiyan, Mark G. Rabbat, Tetsuya Amano, Tomohiro Kawasaki, Takashi Akasaka, Hironori Kitabata, Campbell Rogers, Manesh R. Patel, Geoffrey W. PayneJonathon A. Leipsic, Stephanie L. Sellers*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)


Purpose: To examine the relationship between smoking status and coronary volume–to–myocardial mass ratio (V/M) among individuals with coronary artery disease (CAD) undergoing CT fractional flow reserve (CT-FFR) analysis. Materials and Methods: In this secondary analysis, participants from the ADVANCE registry evaluated for suspected CAD from July 15, 2015, to October 20, 2017, who were found to have coronary stenosis of 30% or greater at coronary CT angiography (CCTA) were included if they had known smoking status and underwent CT-FFR and V/M analysis. CCTA images were segmented to calculate coronary volume and myocardial mass. V/M was compared between smoking groups, and predictors of low V/M were determined. Results: The sample for analysis included 503 current smokers, 1060 former smokers, and 1311 never-smokers (2874 participants; 1906 male participants). After adjustment for demographic and clinical factors, former smokers had greater coronary volume than never-smokers (former smokers, 3021.7 mm3 ± 934.0 [SD]; never-smokers, 2967.6 mm3 ± 978.0; P =.002), while current smokers had increased myocardial mass compared with never-smokers (current smokers, 127.8 g ± 32.9; never-smokers, 118.0 g ± 32.5; P =.02). However, both current and former smokers had lower V/M than never-smokers (current smokers, 24.1 mm3/g ± 7.9; former smokers, 24.9 mm3/g ± 7.1; never-smokers, 25.8 mm3/g ± 7.4; P <.001 [unadjusted] and P =.002 [unadjusted], respectively). Current smoking status (odds ratio [OR], 0.74 [95% CI: 0.59, 0.93]; P =.009), former smoking status (OR, 0.81 [95% CI: 0.68, 0.97]; P =.02), stenosis of 50% or greater (OR, 0.62 [95% CI: 0.52, 0.74]; P <.001), and diabetes (OR, 0.67 [95% CI: 0.56, 0.82]; P <.001) were independent predictors of low V/M. Conclusion: Both current and former smoking status were independently associated with low V/M.

Original languageEnglish
Article numbere220197
JournalRadiology: Cardiothoracic Imaging
Issue number2
Publication statusPublished - Apr 2024

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