ATHEROSCLEROTIC DISEASE OF THE AORTIC-ARCH AS A RISK FACTOR FOR RECURRENT ISCHEMIC STROKE

Citation
P. Amarenco et al., ATHEROSCLEROTIC DISEASE OF THE AORTIC-ARCH AS A RISK FACTOR FOR RECURRENT ISCHEMIC STROKE, The New England journal of medicine, 334(19), 1996, pp. 1216-1221
Citations number
36
Categorie Soggetti
Medicine, General & Internal
ISSN journal
00284793
Volume
334
Issue
19
Year of publication
1996
Pages
1216 - 1221
Database
ISI
SICI code
0028-4793(1996)334:19<1216:ADOTAA>2.0.ZU;2-1
Abstract
Background. Atherosclerotic disease of the aortic arch is found in 60 percent of patients 60 years of age or older who have had brain infarc tion. The aim of this study was to determine whether atherosclerotic p laques in the aortic arch are a risk factor for recurrent brain infarc tion and for vascular events in general (i.e., brain infarction, myoca rdial infarction, peripheral embolism, and death from vascular causes) . Methods. For a period of two to four years, we followed a cohort of 331 patients 60 years of age or older who were consecutively admitted to the hospital with brain infarction (a total of 788 person-years of follow-up). All patients underwent transesophageal echocardiography to determine whether atherosclerotic plaques were present in the aortic arch proximal to the ostium of the left subclavian artery. The patient s were divided into three groups according to the thickness of the wal l of the aortic arch (<1 mm, 1 to 3.9 mm, and greater than or equal to 4 mm). Results. The incidence of recurrent brain infarction was 11.9 per 100 person-years in patients with an aortic-wall thickness of grea ter than or equal to 4 mm, as compared with 3.5 per 100 person-years i n patients with a wall thickness of 1 to 3.9 mm and 2.8 per 100 person -years in patients with a wall thickness of <1 mm (P<0.001). The overa ll incidence of vascular events was 26.0, 9.1, and 5.9 per 100 person- years of follow-up in the respective groups (P<0.001). After adjustmen t for the presence of carotid stenosis, atrial fibrillation, periphera l arterial disease, and other risk factors, aortic plaques greater tha n or equal to 4 mm thick (including the thickness of the aortic wall) were found to be independent predictors of recurrent brain infarction (relative risk, 3.8; 95 percent confidence interval, 1.8 to 7.8; P=0.0 012) and of all vascular events (relative risk, 3.5; 95 percent confid ence interval, 2.1 to 5.9; P<0.001). Conclusions. Atherosclerotic plaq ues greater than or equal to 4 mm thick in the aortic arch are signifi cant predictors of recurrent brain infarction and other vascular event s. (C) 1996, Massachusetts Medical Society.