Abstract 5750: Protruding Atheroma in the Thoracic Aorta Detected by Multislice Computed Tomography Can Predict the Future Vascular Events
(Purpose) Protruding atheroma in the thoracic aorta (PATA) has been reported to be associated with coronary artery disease and future embolic disease in previous studies using transesophageal echocardiography. Recently multislice computed tomography (MSCT) has been available for the diagnosis of coronary artery disease and it can also detect PATA. The clinical impact of PATA detected by MSCT has not been examined. The purpose of this study was to investigate whether the presence of PATA by MSCT can predict future vascular events (coronary revascularization (CR) and embolic events).
(Methods) From November 2005 to March 2008, 511 consecutive patients (male 56%, age 66±11y.o.) with suspected ischemic heart disease underwent MSCT. The exclusion criteria were atrial fibrillation, renal insufficiency, or a history of CR or cardiothoracic surgery. According to the aortic plaque thickness, we divided patients into 3 groups: Group 1 (<2mm, n=332), Group 2 (2– 4mm, n=146), Group 3 (>4mm, PATA, n=33).
(Results) Risk factors were: hypertension (68%), diabetes (41%), hypercholesterolemia (57%), and smoking (44%). During follow-up period (15.6-month median), CR was required for 68 patients (59 PCI and 9 CABG). Univariate analysis showed that the patients required for CR were of significantly higher prevalence of all the risk factors, aortic plaque (Group 2, 3) and calcification of coronary artery, aortic and mitral valve. Multivariate analysis showed that requirement of CR was independently associated with aortic plaque, smoking, or coronary calcification, and PATA revealed the highest odds (odds ratio 7.4, 95% confidence interval 3.1 to 17.6) among them. Embolic events occurred in 7 patients (5 brain, 1 bowel, and 1 kidney and lower extremity) during follow-up period. By univariate analysis, only smoking and PATA revealed significantly higher prevalence in patients with embolic events (p=0.02 and<.0001, respectively). Multivariate analysis showed that PATA was an independent predictor for future embolic events (odds ratio 10.7, 95% confidence interval 1.6 to 70.4).
(Conclusions) PATA detected by MSCT can predict future vascular events. We should be aware of the presence of PATA by MSCT as a risk for the future cardiovascular events.