CLINICAL STUDIES
Atherosclerosis of the thoracic aorta and aortic debris as a marker of poor prognosis: benefit of oral anticoagulants
Emile Ferrari, MDa,
Renaud Vidal, MDa,
Thierry Chevallier, MDa and
Marcel Baudouy, MDa
a Cardiology Department, Hopital Pasteur, Nice, France
Manuscript received July 30, 1998;
revised manuscript received November 11, 1998,
accepted December 24, 1998.
Reprint requests and correspondence: Dr. Emile Ferrari, 30 Avenue de la Voie Romaine, B.P. 69 06002 Nice, France
eferrari{at}unice.fr
OBJECTIVES
Our aim was to confirm the poor prognosis related to thoracic aortic plaques, in particular aortic debris, diagnosed by transesophageal echocardiography (TEE) and to evaluate patients’ prognosis as a function of the antithrombotic treatment.
BACKGROUND
Aortic atheroma (AA) has been widely studied. However, it is still not known which antithrombotic treatment should be adopted in this disease.
METHODS
Patients referred for TEE and diagnosed with AA were followed. All thromboembolic events and deaths were recorded during a follow-up of 22 ± 10 months. The antithrombotic treatment to be adopted was left to the discretion of the practitioner in charge of the patient.
RESULTS
Aortic atheroma was found in 12% of all TEE performed and in 27.5% of TEE performed for stroke. This prevalence was higher when no other etiology existed to explain the stroke (p < 0.001). During follow-up, an end point occurred in 22.5% of patients. The more severe the AA the greater the incidence of events (p = 0.007). A higher mortality rate is shown in patients with aortic debris (p = 0.049). Compared with those treated with oral anticoagulants, patients with aortic plaques >4 mm thick treated with antiplatelets had more embolic events and combined events (p = 0.01 and p = 0.007, relative risk [RR] = 5.9, 95% confidence interval [CI] = 1.4 to 15, respectively); patients with aortic debris had more combined events and a higher mortality rate (p = 0.001, RR = 7.1, 95% CI = 1.2 to 19 and p = 0.019, RR = 9.1, 95% CI = 1.2 to 25, respectively).
CONCLUSIONS
We confirm the high incidence of vascular events and deaths in patients with AA. We have demonstrated, for the first time in this condition, a better outcome among patients treated with oral anticoagulants versus antiplatelets.
|
Abbreviations and Acronyms
| | AA | = aortic atheroma | | APA | = antiplatelet agents | | CI | = confidence interval | | OAC | = oral anticoagulants | | RR | = relative risk | | TEE | = transesophageal echocardiography |
|
This article has been cited by other articles:
|
|
|
|
 
R. A. Krasuski, S. A. Hart, D. Allen, A. Qureshi, G. Pettersson, P. L. Houghtaling, L. H. Batizy, and E. Blackstone
Prevalence and Repair of Intraoperatively Diagnosed Patent Foramen Ovale and Association With Perioperative Outcomes and Long-term Survival
JAMA,
July 15, 2009;
302(3):
290 - 297.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Russo, Z. Jin, T. Rundek, S. Homma, R. L. Sacco, and M. R. Di Tullio
Atherosclerotic Disease of the Proximal Aorta and the Risk of Vascular Events in a Population-Based Cohort: The Aortic Plaques and Risk of Ischemic Stroke (APRIS) Study
Stroke,
July 1, 2009;
40(7):
2313 - 2318.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. N. Khouzam
Mobile Aortic Atheroma Leading to a Cerebrovascular Accident
Circulation,
February 10, 2009;
119(5):
e192 - e192.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. Oishi, N. Hirahara, T. Takaseya, T. Kawara, M. Yasaka, and S. Morita
Graft Replacement for Massive Mobile Embolic Source in Brachiocephalic Artery
Asian Cardiovasc Thorac Ann,
December 1, 2008;
16(6):
e58 - e59.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. P. Ward, G. Lammertin, D. E. Virnich, T. S. Polonsky, and R. M. Lang
Use of Carotid Intima-Media Thickness to Identify Patients With Ischemic Stroke and Transient Ischemic Attack With Low Yield of Cardiovascular Sources of Embolus on Transesophageal Echocardiography
Stroke,
November 1, 2008;
39(11):
2969 - 2974.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. R. Di Tullio, S. Homma, Z. Jin, and R. L. Sacco
Aortic Atherosclerosis, Hypercoagulability, and Stroke: The APRIS (Aortic Plaque and Risk of Ischemic Stroke) Study
J. Am. Coll. Cardiol.,
September 2, 2008;
52(10):
855 - 861.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. N. Salem, P. T. O'Gara, C. Madias, and S. G. Pauker
Valvular and Structural Heart Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)
Chest,
June 1, 2008;
133(6_suppl):
593S - 629S.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. W. Albers, P. Amarenco, J. D. Easton, R. L. Sacco, and P. Teal
Antithrombotic and Thrombolytic Therapy for Ischemic Stroke: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)
Chest,
June 1, 2008;
133(6_suppl):
630S - 669S.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. E. Glas, M. Swaminathan, S. T. Reeves, J. S. Shanewise, D. Rubenson, P. K. Smith, J. P. Mathew, S. K. Shernan, and Council for Intraoperative Echocardiography of the
Guidelines for the Performance of a Comprehensive Intraoperative Epiaortic Ultrasonographic Examination: Recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists; Endorsed by the Society of Thoracic Surgeons
Anesth. Analg.,
May 1, 2008;
106(5):
1376 - 1384.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. K. Thambidorai, S. J. Jaffer, T. K. Shah, W. J. Stewart, A. L. Klein, and M. S. Lauer
Association of atheroma as assessed by intraoperative transoesophageal echocardiography with long-term mortality in patients undergoing cardiac surgery
Eur. Heart J.,
June 6, 2007;
(2007)
ehm180v1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. F. Ford and M. A. Farber
Role of Endovascular Therapies in the Management of Diverse Thoracic Aortic Pathology
Perspectives in Vascular Surgery and Endovascular Therapy,
June 1, 2007;
19(2):
134 - 143.
[Abstract]
[PDF]
|
|
|
|
|
|
|
D. Renard and N. Stober
Cerebral and Peripheral Embolism of Aortic Origin
Arch Neurol,
June 1, 2007;
64(6):
894 - 895.
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. Kronzon and P. A. Tunick
Aortic Atherosclerotic Disease and Stroke
Circulation,
July 4, 2006;
114(1):
63 - 75.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. N. Djaiani
Aortic arch atheroma: stroke reduction in cardiac surgical patients.
Seminars in Cardiothoracic and Vascular Anesthesia,
June 1, 2006;
10(2):
143 - 157.
[Abstract]
[PDF]
|
|
|
|
|
|
|
A. Harloff, M. Handke, M. Reinhard, A. Geibel, and A. Hetzel
Therapeutic Strategies After Examination by Transesophageal Echocardiography in 503 Patients With Ischemic Stroke
Stroke,
March 1, 2006;
37(3):
859 - 864.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. P. Ward, C. W. Don, K. T. Furlong, and R. M. Lang
Predictors of Long-Term Mortality in Patients With Ischemic Stroke Referred for Transesophageal Echocardiography
Stroke,
January 1, 2006;
37(1):
204 - 208.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Schachner, A. Zimmer, G. Nagele, G. Laufer, and J. Bonatti
Risk factors for late stroke after coronary artery bypass grafting
J. Thorac. Cardiovasc. Surg.,
August 1, 2005;
130(2):
485 - 490.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V Caso, K Budak, D Georgiadis, B Schuknecht, and R W Baumgartner
Clinical significance of detection of multiple acute brain infarcts on diffusion weighted magnetic resonance imaging
J. Neurol. Neurosurg. Psychiatry,
April 1, 2005;
76(4):
514 - 518.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Ovbiagele, C. S. Kidwell, and J. L. Saver
Expanding Indications for Statins in Cerebral Ischemia: A Quantitative Study
Arch Neurol,
January 1, 2005;
62(1):
67 - 72.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. N. Salem, P. D. Stein, A. Al-Ahmad, H. I. Bussey, D. Horstkotte, N. Miller, and S. G. Pauker
Antithrombotic Therapy in Valvular Heart Disease--Native and Prosthetic: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy
Chest,
September 1, 2004;
126(3_suppl):
457S - 482S.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. W. Albers, P. Amarenco, J. D. Easton, R. L. Sacco, and P. Teal
Antithrombotic and Thrombolytic Therapy for Ischemic Stroke: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy
Chest,
September 1, 2004;
126(3_suppl):
483S - 512S.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. D. Flemming, R. D. Brown Jr, G. W. Petty, J. Huston III, D. F. Kallmes, and D. G. Piepgras
Evaluation and Management of Transient Ischemic Attack and Minor Cerebral Infarction
Mayo Clin. Proc.,
August 1, 2004;
79(8):
1071 - 1086.
[Abstract]
[PDF]
|
|
|
|
|
|
|
F. O'Rourke, N. Dean, N. Akhtar, and A. Shuaib
Current and future concepts in stroke prevention
Can. Med. Assoc. J.,
March 30, 2004;
170(7):
1123 - 1133.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. V. Milani, C. J. Lavie, Y. E. Gilliland, M. M. Cassidy, and J. A. Bernal
Overview of Transesophageal Echocardiography for the Chest Physician
Chest,
September 1, 2003;
124(3):
1081 - 1089.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Kuhlkamp, L. Seipel, E. C. Healy, K. Bhaskarabhatla, W. J. Manning, D. G. Wyse, I. C. Van Gelder, and H. J.G.M. Crijns
Atrial Fibrillation -- Rate versus Rhythm Control
N. Engl. J. Med.,
March 27, 2003;
348(13):
1284 - 1286.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. van der Loo, E. Oechslin, R. Jenni, A. Cohen, and P. Amarenco
Assessment of Atherosclerotic Plaques of the Aortic Arch
N. Engl. J. Med.,
September 19, 2002;
347(12):
949 - 949.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Lochow, A. Schwartzbard, J. Guest, C. Ripps, D. Matalon, R. Gambetta, P. A. Tunick, and S. Sedlis
Elevated Prothrombin and Activated Protein C Resistance in Patients with Thoracic Aortic Atheroma
Angiology,
July 1, 2002;
53(4):
423 - 428.
[Abstract]
[PDF]
|
|
|
|
|
|
|
C. Knottenbelt, P. J. Brennan, T. W. Meade, and for the Medical Research Council's General Practic
Antithrombotic Treatment and the Incidence of Angina Pectoris
Arch Intern Med,
April 22, 2002;
162(8):
881 - 886.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Nakagawa, T. Hirai, N. Shinokawa, S. Takashima, T. Nozawa, H. Asanoi, and H. Inoue
Aortic Spontaneous Echocardiographic Contrast and Hemostatic Markers in Patients With Nonrheumatic Atrial Fibrillation
Chest,
February 1, 2002;
121(2):
500 - 505.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. Lalouschek, W. Lang, and M. Mullner
Current Strategies of Secondary Prevention After a Cerebrovascular Event: The Vienna Stroke Registry
Stroke,
December 1, 2001;
32(12):
2860 - 2866.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. J. Powers
Oral Anticoagulant Therapy for the Prevention of Stroke
N. Engl. J. Med.,
November 15, 2001;
345(20):
1493 - 1495.
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Shinokawa, T. Hirai, S. Takashima, T. Kameyama, K. Nakagawa, H. Asanoi, and H. Inoue
A Transesophageal Echocardiographic Study on Risk Factors for Stroke in Elderly Patients With Atrial Fibrillation : A Comparison With Younger Patients
Chest,
September 1, 2001;
120(3):
840 - 846.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. A. Shunk, J.e. Garot, E. Atalar, and J. A. C. Lima
Transesophageal magnetic resonance imaging of the aortic arch and descending thoracic aorta in patients with aortic atherosclerosis
J. Am. Coll. Cardiol.,
June 15, 2001;
37(8):
2031 - 2035.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. N. Salem, D. Hartnett Daudelin, H. J. Levine, S. G. Pauker, M. H. Eckman, and J. Riff
Antithrombotic Therapy in Valvular Heart Disease
Chest,
January 1, 2001;
119
(2009):
207S - 219S.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. W. Albers, P. Amarenco, J. D. Easton, R. L. Sacco, and P. Teal
Antithrombotic and Thrombolytic Therapy for Ischemic Stroke
Chest,
January 1, 2001;
119
(2009):
300S - 320S.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. R. Di Tullio, R. L. Sacco, M. T. Savoia, R. R. Sciacca, and S. Homma
Gender Differences in the Risk of Ischemic Stroke Associated With Aortic Atheromas
Stroke,
November 1, 2000;
31(11):
2623 - 2627.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. A. Tunick and I. Kronzon
Atheromas of the thoracic aorta: clinical and therapeutic update
J. Am. Coll. Cardiol.,
March 1, 2000;
35(3):
545 - 554.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. L. Babikian and L. R. Caplan
Brain embolism is a dynamic process with variable characteristics
Neurology,
February 22, 2000;
54(4):
797 - 801.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. G. Hart and J. L. Halperin
Atrial Fibrillation and Thromboembolism: A Decade of Progress in Stroke Prevention
Ann Intern Med,
November 2, 1999;
131(9):
688 - 695.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Oral Anticoagulation for Aortic Atheroma
Journal Watch Cardiology,
July 9, 1999;
1999(709):
1 - 1.
[Full Text]
|
|
|
|
|
|
|
Aortic Atherosclerosis a Treatable Risk Factor
Journal Watch (General),
May 4, 1999;
1999(504):
3 - 3.
[Full Text]
|
|
|
|
