Abstract 2772: Relation Between High-Risk Coronary Anatomy and Aortic Atherosclerotic Plaques in Patients Undergoing Coronary Angiography and Transesophageal Echocardiography
High-risk coronary anatomy (HRCA) was defined as ≥ 50% stenosis of left main coronary artery and /or significant 3-vessel coronary artery disease (≥70% narrowing). The impact of thoracic aortic atherosclerotic plaques (ASP) in frequency of HRCA is largely unknown. We hypothesized that there is relation between ASP and incidence of HRCA.
Methods: We studied 187 consecutive patients with coronary angiography and transesophageal echocardiography (TEE) [male/ female 112/75, age 67.5± 11.2 years]. The patients with left atrial thrombus by TEE were excluded. The ASP severity was classified as Grades I (normal or minimal intimal thickening) in 53; II (extensive intimal thickening) in 73; III (atheroma < 5mm) in 50; IV (atheroma ≥ 5mm) in 6; and V (mobile lesion) in 5 patients. ASP ≥ III grade was defined as significant. The age, gender, incidence of previous myocardial infarction, diabetes, hypertension, hyperlipidemia, aortic stenosis, aortic valve calcification, mitral annulus calcification (MAC), body mass index (BMI), left ventricular hypertrophy (LVH), smoking and mortality were evaluated in patients with and without ASP ≥ III grade.
Results: There were 36 patients who had HRCA. Multivariate regression analysis showed that ASP ≥ III grade (p= 0.04), male (p< 0.0001) and incidence of previous myocardial infarction (p=0.001) were independent predictors of HRCA. Age (70± 10.9 vs 66.3± 11.2, p= 0.03), incidence of hyperlipidemia (p= 0.004) and incidence of aortic stenosis (p= 0.02) in patients with ASP ≥ III grade were greater than in patients with ASP < III. There was no significant difference in incidence of diabetes (p= 0.49), hypertension (p= 0.09), aortic valve calcification (p= 0.33), MAC (p= 0.55), BMI (27.2± 4.7 vs 28.7± 6.7, p= 0.13), LVH (p= 0.19) and smoking (p= 0.88) between the patients with and without ASP ≥ III grade. The total mortality in patients with ASP ≥ III grade (14/61, 61%) was significantly higher than ASP < III grade (11/126, 17%, p= 0.01).
Conclusion: The ASP ≥ III grade, male sex and incidence of previous myocardial infarction are directly related to the high-risk coronary anatomy. Age, incidence of aortic stenosis and hyperlipidemia and mortality were significantly higher in patients with ASP ≥ III grade.