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European Heart Journal Advance Access originally published online on June 6, 2007
European Heart Journal 2007 28(12):1454-1461; doi:10.1093/eurheartj/ehm180
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Association of atheroma as assessed by intraoperative transoesophageal echocardiography with long-term mortality in patients undergoing cardiac surgery

Senthil K. Thambidorai, Sukaina J. Jaffer, Tushar K. Shah, William J. Stewart, Allan L. Klein* and Michael S. Lauer

Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue—Desk F15, Cleveland, OH 44195, USA

Received 29 September 2006; revised 22 March 2007; accepted 13 April 2007; online publish-ahead-of-print 6 June 2007.

* Corresponding author. Tel: +1216 444 3932; fax: +1 216 445 2309. E-mail address: kleina{at}ccf.org

Aims: To determine whether the presence and severity of aortic atheroma predict long-term all-cause mortality among patients undergoing cardiac surgery.

Methods and results: We followed 8581 patients who underwent cardiac surgery and had routine intraoperative transoesophageal echocardiography for 2.8 years (range 0.06–6.0 years). Data regarding multiple potential confounders were prospectively collected and electronically recorded. There were 2878 (34%) patients with no atheroma; 4129 (48%) patients with mild atheroma; 1215 (14%) with moderate atheroma; and 359 (4%) with severe atheroma. There were 1000 deaths. Death rates were increased in patients with moderate [relative risk (RR) 3.29, 95% CI 2.50–4.32, P < 0.0001) and severe atheroma (RR 5.21, 95% CI 3.65–7.41, P < 0.0001). After adjusting for multiple other confounders, severe atheroma remained modestly predictive of risk (adjusted RR 1.46, 95% CI 1.07–2.00, P = 0.02); but moderate atheroma and mild atheroma were not predictive of increased risk. In a propensity analysis that matched patients with comparable range of variables, severe atheroma was no longer predictive of risk (adjusted RR 1.39, 95% CI 0.87–2.23, P = 0.17).

Conclusion: Our study shows that severe atheroma is associated with increased long-term mortality in patients undergoing cardiac surgery; however, the relationship is weak using propensity analysis, suggesting no causal association.

Key Words: Atheroma • Intraoperative echocardiography • Survival


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