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Eur J Intern Med. 2014 Jun;25(5):452-7. doi: 10.1016/j.ejim.2014.03.017. Epub 2014 May 3.

Attenuated predictive power of a normal myocardial perfusion scan in young smokers.

Author information

1
Cardiology Department, Soroka University Medical Center, Beer-Sheva 84101, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel.
2
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel.
3
Clinical Research Center, Soroka University Medical Center, Beer-Sheva 84101, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel.
4
Cardiology Department, Soroka University Medical Center, Beer-Sheva 84101, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel. Electronic address: yaakovh@bgu.ac.il.

Abstract

BACKGROUND:

The 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.

METHODS:

The 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.

RESULTS:

During 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).

CONCLUSIONS:

In 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.

KEYWORDS:

Mortality; Myocardial infarction; Nuclear medicine; Perfusion; Smoking

PMID:
24793836
DOI:
10.1016/j.ejim.2014.03.017
[Indexed for MEDLINE]

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