Impact of Concomitant Coronary Artery Disease on Atherosclerotic Plaques in the Aortic Arch in Patients With Severe Aortic Stenosis

Background: Coronary artery disease (CAD) often occurs concurrently in patients with severe aortic stenosis (AS). However, the influence of concomitant CAD on the presence of atherosclerotic complex plaques in the aortic arch, which is associated with increased stroke risk, has not been fully assessed in patients with severe AS. Hypothesis: We hypothesized that concomitant CAD would be associated with the presence of complex arch plaques in patients with severe AS. Methods: The study population consisted of 154 patients with severe AS who had undergone transesophageal echocardiography (TEE) and coronary angiography (71 male; mean age, 72 +/- 8 years; mean aortic valve area, 0.67 +/- 0.15 cm(2)). Aortic arch plaques were assessed using TEE, and complex arch plaques were defined as large plaques (>= 4 mm), ulcerated plaques, or mobile plaques. Results: The prevalence of aortic arch plaques (87% vs 70%; P=0.03) and complex arch plaques (48% vs 20%; P<0.001) was significantly greater in AS patients with CAD than in those without CAD. After adjustment for traditional atherosclerotic risk factors, we found that concomitant CAD was independently associated with the presence of complex arch plaques (odds ratio: 2.86, 95% confidence interval: 1.23-6.68, P=0.01). Conclusions: In patients with severe AS, concomitant CAD is associated with severe atherosclerotic burden in the aortic arch. This observation suggests that AS patients with concomitant CAD are at a higher risk for stroke, and that careful evaluation of complex arch plaques by TEE is needed for the risk stratification of stroke in these patients.