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Rohit Arora

Rohit Arora

Professor of Medicine, Chicago Medical School, USA

Title: Effect of smoking on coronary microvasculature in hospitalized chest pain patients

Biography

Biography: Rohit Arora

Abstract

Background: Multiple studies demonstrate increased Thrombosis in Myocardial Infarction (TIMI) frame count (cTFC) among tobacco    smokers (TS) even in the absence of epicardial coronary artery disease (CAD), suggestive of coronary microvascular dysfunction (MD). Among those patients who present with chest pain and a positive stress test, we hypothesize that the extent of MD is larger among TS when compared to non-smokers (NS).
Method: In this retrospective study, patients who underwent coronary angiogram for chest pain with a positive stress test were grouped into TS and NS. Among these, those who were free of a significant CAD, vasospasm or recent myocardial infarction were randomly chosen: 82 TS and 127 NS. Presence of coronary MD was assessed using cTFC and TIMI perfusion grade (TMPG).
Results: At baseline, TS were significantly younger compared to NS (mean age in years 50.2 vs 58.56, p<0.0001) with significantly more females in the NS group. The cTFC and TMPG for left anterior descending, left circumflex and right coronary arteries though significantly higher in both groups, when compared to published normals, there was no significant difference observed. Additional sub-group analysis for gender and age (<50 years and  ≥50 years) also did not demonstrate any significant differences. Furthermore, among patients with no history of hypertension, diabetes mellitus and hyperlipidemia, no significant differences were observed between the two groups.
Conclusion: Increased cTFC in both the groups indicates increased coronary microvascular resistance suggesting MD, which may be the reason for a positive stress test. This study demonstrates that among patients presenting with chest pain and a positive stress test, in the absence of significant epicardial CAD, tobacco smoking does not further increase MD.

Recent Publications:

  1. Crea F, Camici PG, Bairey Merz CN.Coronary microvascular dysfunction: an update.Eur Heart J. 2014 May;35(17):1101-11. doi: 10.1093/eurheartj/eht513.
  2. The TIMI Study Group. The Thrombolysis In Myocardial Infarction (TIMI) trial. N Engl J Med. 1985;31:932–936.
  3. Gibson CM, Cannon CP, Murphy SA, et al. Relationship of TIMI Myocardial Perfusion Grade to Mortality After Administration of Thrombolytic Drugs. Circulation. 2000;101:125.
  4. Gibson CM, Cannon CP,  Daley WL, et al. TIMI Frame Count. Circulation. 1996;93:879-888.
  5. Erbay, Ali Riza et al. “Documentation of slow coronary flow by the thrombolysis in myocardial infarction frame count in habitual smokers with angiographically normal coronary arteries.” Heart and Vessels 19 (2004): 271-274.