Extent of thoracic aortic atheroma burden and long-term mortality after cardiothoracic surgery: a computed tomography study.
OBJECTIVE
We hypothesized that the extent of aortic atheroma of the entire thoracic aorta, determined by pre-operative multidetector-row computed tomographic angiography (MDCTA), is associated with long-term mortality following nonaortic cardiothoracic surgery.


BACKGROUND
In patients evaluated for cardiothoracic surgery, presence of severe aortic atheroma is associated with adverse short- and long-term post-operative outcome. However, the relationship between aortic plaque burden and mortality remains unknown.


METHODS
We reviewed clinical and imaging data from all patients who underwent electrocardiographic-gated contrast-enhanced MDCTA prior to coronary bypass or valvular heart surgery at our institution between 2002 and 2008. MDCTA studies were analyzed for thickness and circumferential extent of aortic atheroma in 5 segments of the thoracic aorta. A semiquantitative total plaque-burden score (TPBS) was calculated by assigning a score of 1 to 3 to plaque thickness and to circumferential plaque extent. When combined, this resulted in a score of 0 to 6 for each of the 5 segments and, hence, an overall score from 0 to 30. The primary end point was all-cause mortality during long-term follow-up.


RESULTS
A total of 862 patients (71% men, 67.8 years) were included and followed over a mean period of 25 ± 16 months. The mean TPBS was 8.6 (SD: ±6.0). The TPBS was a statistically significant predictor of mortality (p < 0.0001) while controlling for baseline demographics, cardiovascular risk factors, and type of surgery including reoperative status. The estimated hazard ratio for TPBS was 1.08 (95% confidence interval: 1.045 to 1.12). Other independent predictors of mortality were glomerular filtration rate (p = 0.015), type of surgery (p = 0.007), and peripheral artery disease (p = 0.03).


CONCLUSIONS
Extent of thoracic aortic atheroma burden is independently associated with increased long-term mortality in patients following cardiothoracic surgery. Although our data do not provide definitive evidence, they suggest a relationship to the systemic atherosclerotic disease process and, therefore, have important implications for secondary prevention in post-operative rehabilitation programs.
Imaging Institute, Cleveland Clinic, Cleveland, Ohio 44106, USA.
Vikram
V
Kurra
Michael L
ML
Lieber
Srikanth
S
Sola
Vidyasagar
V
Kalahasti
Donald
D
Hammer
Stephen
S
Gimple
Scott D
SD
Flamm
Michael A
MA
Bolen
Sandra S
SS
Halliburton
Tomislav
T
Mihaljevic
Milind Y
MY
Desai
Paul
P
Schoenhagen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging*; D001018:Aortic Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality; D001027:Aortography / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D016009:Chi-Square Distribution; D003287:Contrast Media; D001026:Coronary Artery Bypass / Q000401:mortality*; D005260:Female; D005919:Glomerular Filtration Rate; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000150:complications / Q000401:mortality; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D003287:Contrast Media