Impact of ascending aortic wall thickness and atherosclerosis on the intermediate survival after coronary artery bypass surgery.

OBJECTIVES We investigated the prognostic impact of atherosclerosis and wall thickness of the ascending aorta in patients undergoing coronary artery bypass grafting (CABG). METHODS A series of 781 patients who underwent CABG and in whom epiaortic ultrasound was performed to assess the status of the ascending aorta and to measure the thickness of its anterior and lateral walls were the subjects of the present analysis. RESULTS At multivariate analysis, thickness of the ascending aortic wall, but not atherosclerosis, was an independent predictor of all-cause intermediate mortality [relative risk (RR): 1.628; 95% confidence interval (CI): 1.219-2.176]. Five-year overall survival rates in patients with an aortic wall thickness ≥1.8 mm and less were 82.2 and 92.6%, respectively (log-rank test: P < 0.0001). Ascending aortic wall thickness (RR: 1.629; 95% CI: 1.135-2.339), but not atherosclerosis, was also an independent predictor of cardiovascular mortality. Aortic wall thickness ≥1.8 mm combined with the presence of atherosclerosis of the ascending aorta was associated with a rather dismal overall survival compared with patients with normal findings at epiaortic ultrasound (at 5 years, 77.0 vs. 93.2%; adjusted analysis: P = 0.010). CONCLUSIONS Ascending aortic wall thickness, but not the presence of atherosclerosis of any extent, is an independent predictor of intermediate all-cause and cardiovascular mortality. Thickened aortic wall is associated with significantly higher hazard of all cause and cardiovascular mortality and can be considered an important surrogate marker of aggressive atherosclerosis.