%0 Journal Article %A Adaani Frost %A Carol Zhao %A Harrison Farber %A Raymond Benza %A Mona Selej %A Greg Elliott %T Smoking history and pulmonary arterial hypertension (PAH) onset and clinical outcomes (REVEAL) %D 2020 %R 10.1183/13993003.congress-2020.3552 %J European Respiratory Journal %P 3552 %V 56 %N suppl 64 %X Aim: Data on impact of smoking on pulmonary hypertension is conflicting. REVEAL (Registry to Evaluate Early and Long-term PAH Disease Management) a US-based, multicentre observational registry characterising clinical features and outcomes of PAH patients (pts) was queried to assess the relationship between smoking status (NEVER- vs EVER-smoker) and onset and outcome in PAH.Methods: REVEAL (NCT00370214) pts ≥18 years (yrs), group 1 PAH, with pulmonary capillary wedge pressure ≤15 mmHg at diagnosis were included. 5-yr mortality (all cause), the composite of transplant or mortality and time to first hospitalisation were evaluated for NEVER- vs EVER-smokers, and by newly vs previously diagnosed pts unadjusted (un-) and adjusted (adj) for age, time from diagnosis to enrolment, sex and log transformed pulmonary vascular resistance (PVR).Results: NEVER (N=1619) vs EVER-smokers (N=1427) differed for: median age at diagnosis, 48.3 vs 52.5 years; obstructive lung disease, 7.8% vs 21.7%; male, 15.2% vs 27.8% (all p<0.001). 5-yr mortality did not differ for EVER- vs NEVER-smokers overall. Newly diagnosed EVER-smokers vs NEVER smokers (adj and un- for PVR and gender) had a higher risk of mortality (adj hazard ratio [HR] 1.33 [95% CI, 1.05-1.69; p=0.019]; un- HR 1.41, 95% CI 1.12-1.78, p=0.0039); composite of transplant or mortality (adj HR 1.38 [95% CI, 1.09–1.73 p=0.007]; un- HR 1.46 [95% CI 1.16-1.83,p=0.0012]) and hospitalisation (adj HR 1.25 [95% CI, 1.03–1.51; p=0.022]; un- HR 1.27 [95%CI 1.06-1.53, p=0.0012]).Conclusions: In REVEAL, PAH pts who were EVER- vs NEVER-smoker were older at diagnosis. In newly diagnosed PAH pts smoking was associated with worse clinical outcomes irrespective of PVR.FootnotesCite this article as: European Respiratory Journal 2020; 56: Suppl. 64, 3552.This abstract was presented at the 2020 ERS International Congress, in session “Respiratory viruses in the "pre COVID-19" era”.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only). %U