Effect of treatment on the incidence of stroke and other emboli in 519 patients with severe thoracic aortic plaque.
Severe aortic plaques seen on transesophageal echocardiography (TEE) are a high-risk cause of stroke and peripheral embolization. Evidence to guide therapy is lacking. Retrospective information was obtained regarding the occurrence of embolic events (stroke, transient ischemic attacks, or peripheral emboli) in 519 patients with severe thoracic aortic plaque seen on TEE since 1988. Treatment with statins, warfarin, or antiplatelet medications was noted. Treatment was not randomized. In a matched-paired analysis, each patient taking each class of therapy was matched for age, gender, previous embolic event, hypertension, diabetes, congestive failure, and atrial fibrillation to someone not taking that medication. Multivariate analysis was also performed. An embolic event occurred in 111 patients (21%). Multivariate analysis showed that statin use was independently protective against recurrent events (p = 0.0001). Matched analysis also showed a protective effect of statins (p = 0.0004; absolute risk reduction 17%, relative risk reduction 59%, number needed to treat [n = 6]). No protective effect was found for warfarin or antiplatelet drugs. The odds ratio for embolic events was 0.3 (95% confidence interval [CI] 0.2 to 0.6) for statin therapy, 0.7 (95% CI 0.4 to 1.2) for warfarin, and 1.4 (95% CI 0.8 to 2.4) for antiplatelet agents. Thus, there is a protective effect of statin therapy, and no significant benefit of warfarin or antiplatelet drugs on the incidence of stroke and other embolic events in patients with severe thoracic aortic plaque on TEE.
Tunick
Paul A
PA
Noninvasive Cardiology Laboratory, Cardiology Division, Department of Medicine, New York University School of Medicine, New York, New York 10016, USA. Paul.Tunick@med.nyu.edu
Nayar
Ambika C
AC
Goodkin
Gregory M
GM
Mirchandani
Sunil
S
Francescone
Steven
S
Rosenzweig
Barry P
BP
Freedberg
Robin S
RS
Katz
Edward S
ES
Applebaum
Robert M
RM
Kronzon
Itzhak
I
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy*; D001161:Arteriosclerosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D017548:Echocardiography, Transesophageal; D004617:Embolism / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology* / Q000517:prevention & control; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin