Atherosclerosis of the ascending aorta is an independent predictor of long-term neurologic events and mortality

OBJECTIVES This study was undertaken to determine whether atherosclerosis o f the ascending aorta is a predictor of long-term neurologic events and mor tality. BACKGROUND Atherosclerosis of the thoracic aorta has been recently consider ed a significant predictor of neurologic events and peripheral embolism, bu t not;flong-term mortality. METHODS Long-term follow-up (a total of 5,859 person-years) was conducted o f 1,957 consecutive patients greater than or equal to 50 years old who unde rwent cardiac surgery. Atherosclerosis of the ascending aorta was assessed intraoperatively (epiaortic ultrasound) and patients were divided into four groups according to severity (normal, mild, moderate or severe). Carotid a rtery disease was evaluated (carotid ultrasound) in 1,467 (75%) patients. C ox proportional-hazards regression analysis was performed to assess the ind ependent effect of predictors on neurologic events and mortality. RESULTS A total of 491 events occurred in 472 patients (neurologic events 9 2, all-cause mortality 399). Independent predictors of long-term neurologic events were: hypertension (p = 0.009), ascending aorta atherosclerosis (p = 0.011) and diabetes mellitus (p = 0.015). The independent predictors of m ortality were advanced age (p < 0.0001), left ventricular dysfunction (p < 0.0001), ascending aorta atherosclerosis (p < 0.0001), hypertension (p = 0. 0001) and diabetes mellitus (p = 0.0002). There was >1.5-fold Increase In t he incidence of both neurologic events and mortality as the severity of ath erosclerosis increased from normal-mild to moderate, and a greater than thr eefold increase in the incidence of both as the severity of atherosclerosis increased from normal-mild to severe. CONCLUSIONS Atherosclerosis of the ascending aorta is an independent predic tor of long-term neurologic events and mortality. These results provide add itional evidence that in addition to being a direct cause of cerebral ather oembolism, an atherosclerotic ascending aorta may be a marker of generalize d atherosclerosis and thus of increased morbidity and mortality. (C) 1999 b y the American College of Cardiology.