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Vascular events during follow-up in patients with aortic arch atherosclerosis
R Mitusch1, C Doherty, H Wucherpfennig
1Medical Department of Cardiology, University of Lübeck, Germany.
Insights
Complex aortic arch atherosclerosis, characterized by thick or mobile plaques, significantly increases the risk of embolic vascular events. Early identification of these complex plaques is crucial for risk stratification and management.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Diagnostic Imaging
Background:
- Aortic arch atherosclerosis is linked to vascular events.
- Limited data exist on the long-term outcomes of this condition.
Purpose of the Study:
- To prospectively evaluate the risk of vascular events in patients with aortic arch atherosclerosis.
- To identify predictors of vascular events in this patient cohort.
Main Methods:
- 183 patients with aortic arch atherosclerosis diagnosed via echocardiography were followed.
- Patients were categorized based on plaque characteristics: raised plaques (<5 mm thickness) or complex plaques (≥5 mm thickness or mobile components).
Main Results:
- 15 vascular events occurred during a mean follow-up of 16 months.
- Complex plaques were associated with a higher incidence of vascular events (13.7 per 100 person-years) compared to raised plaques (4.1 per 100 person-years).
- Complex plaques, coronary artery disease, and prior embolism were independent predictors of vascular events.
Conclusions:
- Patients with complex aortic arch plaques face a high risk of subsequent vascular events.
- Protruding or mobile plaque components signify elevated embolic risk.
Background And Purpose:
An association between aortic arch atherosclerosis and vascular events has been demonstrated. However, few data exist regarding follow-up evaluation of this disease.
Methods:
In this study, 183 patients with the diagnosis of aortic arch atherosclerosis were prospectively followed up. This diagnosis was made during an echocardiographic cross-sectional study. In 136 patients, raised plaques with thickness < 5 mm had been shown to exist, and in 47 patients complex plaques with thickness > or = 5 mm or plaques with mobile components had been demonstrated on the initial transesophageal echocardiography.
Results:
During a mean follow-up period of 16 +/- 7 months, vascular events with a presumed embolic origin occurred in 15 patients. The incidence was 4.1 per 100 person-years in patients with raised plaques compared with 13.7 per 100 person-years in the group with complex plaques. The Kaplan-Meier survival analysis revealed a significantly higher rate of vascular events in patients who were found to have complex plaques (P < .01). In the Cox proportional hazards analysis, the finding of complex plaques (relative risk [RR], 4.3; 95% confidence interval [CI], 1.5 to 12.0; P = .006), coronary artery disease (RR, 4.0; 95% CI, 1.2 to 13.1; P = .02), and a history of previous embolism (RR, 4.0; 95% CI, 1.1 to 14.4; P = .03) were independent predictors of vascular events.
Conclusions:
Patients with the finding of protruding plaques or plaques with mobile components have a high risk of subsequent vascular events.