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

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.