VASCULAR EVENTS DURING FOLLOW-UP IN PATIENTS WITH AORTIC-ARCH ATHEROSCLEROSIS

Background and Purpose An association between aortic arch atherosclero sis and vascular events has been demonstrated. However, few data exist regarding follow-up evaluation of this disease. Methods In this study , 183 patients with the diagnosis of aortic arch atherosclerosis were prospectively followed up. This diagnosis was made during an echocardi ographic cross-sectional study. In 136 patients, raised plaques with t hickness <5 mm had been shown to exist, and in 47 patients complex pla ques with thickness greater than or equal to 5 mm or plaques with mobi le components had been demonstrated on the initial transesophageal ech ocardiography. Results During a mean follow-up period of 16+/-7 months , vascular events with a presumed embolic origin occurred in 15 patien ts. The incidence was 4.1 per 100 person-years in patients with raised plaques compared with 13.7 per 100 person-years in the group with com plex plaques. The Kaplan-Meier survival analysis revealed a significan tly higher rate of vascular events in patients who were found to have complex plaques (P<.01). In the Cox proportional hazards analysis, the finding of complex plaques (relative risk [RR], 4.3; 95% confidence i nterval [CI], 1.5 to 12.0; P=.006), coronary artery disease (RR, 4.0; 95% CI, 1.2 to 13.1; P=.02), and a history of previous embolism (RR, 4 .0; 95% CI, 1.1 to 14.4; P=.03) were independent predictors of vascula r events. Conclusions Patients with the finding of protruding plaques or plaques with mobile components have a high risk of subsequent vascu lar events.