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Valvular heart disease
Original article
Aortic sclerosis is associated with mortality and major morbidity in patients undergoing coronary artery bypass surgery
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  1. Aidan W Flynn1,
  2. Jonathan Afilalo2,
  3. Arvind K Agnihotri3,
  4. Cristina Castrillo1,
  5. David M Shahian3,4,
  6. Michael H Picard1
  1. 1 Cardiac Ultrasound Laboratory, Division of Cardiology, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
  2. 2 Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Quebec, USA
  3. 3 Division of Cardiac Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
  4. 4 Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
  1. Correspondence to Michael H. Picard, Cardiac Ultrasound Laboratory, Division of Cardiology, Massachusetts General Hospital, Harvard University, 55 Fruit Street, Boston, MA 02114, USA; mhpicard{at}partners.org

Abstract

Objective In this study, we aim to investigate the association between aortic sclerosis and mortality and major morbidity in patients with established coronary artery disease undergoing coronary artery bypass grafting (CABG).

Design Preoperative echocardiograms of consecutive patients undergoing isolated CABG between 2007 and 2009 (n=1150) were analysed, excluding patients without an echocardiogram in the 30 days prior to surgery (n=483). Using logistic regression, we evaluated the association between aortic sclerosis and inhospital mortality and major morbidity. Using Cox proportional hazards, the effect on long-term all-cause mortality was determined.

Setting Massachusetts General Hospital, Boston.

Patients Patients undergoing isolated CABG between 2007 and 2009.

Interventions Analysis of echocardiograms.

Main outcome measures Inhospital mortality and major morbidity, and long-term all-cause mortality.

Results 627 patients were suitable for enrolment; 207 (33%) had significant aortic sclerosis. These patients had higher rates of traditional cardiovascular risk factors. Significant aortic sclerosis was associated with an increased risk of inhospital mortality or major morbidity (OR 1.95; 95% CI 1.25 to 3.04). Following adjustment for baseline clinical and echocardiographic variables, the association remained significant (OR 1.90; 95% CI 1.15 to 3.11). The HR for adjusted all-cause mortality was 2.52 (mean follow-up 2.7 years).

Conclusions Aortic sclerosis is a common finding in patients undergoing CABG. In these patients, its presence is associated with a higher risk of inhospital mortality or major morbidity, and is associated with a higher risk of all-cause long-term mortality independent of other risk factors.

https://doi.org/10.1136/heartjnl-2012-302957

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