Abstract 12724: Smoking is Associated with Presence of Vulnerable Plaques: A Three Vessel Optical Coherence Tomography Study
Background: Smoking is associated with high incidence of cardiovascular events including acute coronary syndrome (ACS). We sought to characterize coronary plaques in patients with ongoing smoking using optical coherence tomography (OCT) compared to former smokers and nonsmokers.
Methods and Results: We identified 465 coronary plaques from 182 subjects who underwent OCT imaging for three coronary arteries. Subjects were divided into 3 groups: current smokers (n=41), former smokers (n=67) and nonsmokers (n=74). OCT analysis included the presence of lipid rich plaque, calcification, maximum lipid arc, lipid core length, lipid index, fibrous cap thickness (FCT) and thin-cap fibroatheroma (TCFA). Lipid index was defined by mean lipid arc multiplied by lipid core length. Current smokers were younger (56.0±11.7 years versus 61.7±9.9 years and 61.6±11.3 years, p =0.014), more likely to present with ACS (63% versus 27% and 45%, p=0.001) and less likely to be taking a statin (39% versus 70% and 74%, p ≤0.001) compared to former and never smokers. Plaques seen in current smokers were more likely to be lipid plaques and TCFAs than in former smokers and nonsmokers (lipid plaques: 68% versus 46% and 53%, p=0.002; TCFA: 18% versus 8% and 10%, p=0.018). There was a trend for higher plaque disruption in current smokers. Former smokers were more likely to have calcified plaques than current and non smokers (53% versus 32% and 38%, p=0.001). Mean lipid arch, lipid length, lipid index, FCT, and thrombus were not significantly different between the groups. In a multivariate analysis, current smoking and presentation with ACS were independently associated with the presence of TCFAs.
Conclusions: Current smokers are more likely to have lipid plaques and OCT defined vulnerable plaques (TCFAs). Former smokers have increased number of calcified plaques. These results may explain the increased risk of acute cardiac events among active smokers.
- © 2013 by American Heart Association, Inc.