title: Association of atheroma as assessed by intraoperative transoesophageal echocardiography with long-term mortality in patients undergoing cardiac surgery.
abstract: OBJECTIVE
  To determine whether the presence and severity of aortic atheroma predict long-term all-cause mortality among patients undergoing cardiac surgery.
  
  
  RESULTS
  We followed 8,581 patients who underwent cardiac surgery and had routine intraoperative transoesophageal echocardiography for 2.8 years (range 0.06-6.0 years). Data regarding multiple potential confounders were prospectively collected and electronically recorded. There were 2,878 (34%) patients with no atheroma; 4,129 (48%) patients with mild atheroma; 1,215 (14%) with moderate atheroma; and 359 (4%) with severe atheroma. There were 1000 deaths. Death rates were increased in patients with moderate [relative risk (RR) 3.29, 95% CI 2.50-4.32, P < 0.0001) and severe atheroma (RR 5.21, 95% CI 3.65-7.41, P < 0.0001). After adjusting for multiple other confounders, severe atheroma remained modestly predictive of risk (adjusted RR 1.46, 95% CI 1.07-2.00, P = 0.02); but moderate atheroma and mild atheroma were not predictive of increased risk. In a propensity analysis that matched patients with comparable range of variables, severe atheroma was no longer predictive of risk (adjusted RR 1.39, 95% CI 0.87-2.23, P = 0.17).
  
  
  CONCLUSIONS
  Our study shows that severe atheroma is associated with increased long-term mortality in patients undergoing cardiac surgery; however, the relationship is weak using propensity analysis, suggesting no causal association.
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue-Desk F15, Cleveland, OH 44195, USA.
authors.forename: Senthil K
authors.initials: SK
authors.lastname: Thambidorai
authors.forename: Sukaina J
authors.initials: SJ
authors.lastname: Jaffer
authors.forename: Tushar K
authors.initials: TK
authors.lastname: Shah
authors.forename: William J
authors.initials: WJ
authors.lastname: Stewart
authors.forename: Allan L
authors.initials: AL
authors.lastname: Klein
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lauer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000000981:diagnostic imaging* / Q000401:mortality*; D050197:Atherosclerosis / Q000000981:diagnostic imaging* / Q000401:mortality*; D006348:Cardiac Surgical Procedures / Q000401:mortality; D017548:Echocardiography, Transesophageal; D005260:Female; D006331:Heart Diseases / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors