Long-term survival in patients presenting with type B: Acute Aortic Dissection insights from the International Registry of Acute Aortic Dissection

• Published in: Circulation (New York, N.Y.) Vol. 114; no. 21; pp. 2226 - 2231
• Main Authors: TSAI, Thomas T, FATTORI, Rossella, PAPE, Linda, FROEHLICH, James, RAGHUPATHY, Arun, JANUZZI, James L, EAGLE, Kim A, NIENABER, Christoph A, TRIMARCHI, Santi, ISSELBACHER, Eric, MYRMEL, Truls, EVANGELISTA, Arturo, HUTCHISON, Stuart, SECHTEM, Udo, COOPER, Jeanna V, SMITH, Dean E
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 21.11.2006
• Subjects: Acute Disease; Aged; Aneurysm, Dissecting - mortality; Aneurysm, Dissecting - therapy; Aortic Aneurysm - mortality; Aortic Aneurysm - therapy; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular system; Diseases of the aorta; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Embolization, Therapeutic - adverse effects; Female; Follow-Up Studies; Hospitalization; Humans; Hypotension - etiology; Investigative techniques, diagnostic techniques (general aspects); Kaplan-Meier Estimate; Male; Medical Records; Medical sciences; Middle Aged; Pleural Effusion - etiology; Proportional Hazards Models; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Registries; Renal Insufficiency - etiology; Sex Factors; Shock - etiology; Treatment Outcome; Vascular Surgical Procedures - adverse effects; Human; risk factors; Mortality; Cardiovascular disease; Survival; Arterial disease; Vascular disease; follow-up studies; Follow up study; Risk factor; Aortic dissection; aorta; Aortic disease
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.106.622340

Follow-up survival studies in patients with acute type B aortic dissection have been restricted to a small number of patients in single centers. We used data from a contemporary registry of acute type B aortic dissection to better understand factors associated with adverse long-term survival. We examined 242 consecutive patients discharged alive with acute type B aortic dissection enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and 2003. Kaplan-Meier survival curves were constructed, and Cox proportional hazards analysis was performed to identify independent predictors of follow-up mortality. Three-year survival for patients treated medically, surgically, or with endovascular therapy was 77.6+/-6.6%, 82.8+/-18.9%, and 76.2+/-25.2%, respectively (median follow-up 2.3 years, log-rank P=0.61). Independent predictors of follow-up mortality included female gender (hazard ratio [HR],1.99; 95% confidence interval [CI], 1.07 to 3.71; P=0.03), a history of prior aortic aneurysm (HR, 2.17; 95% CI, 1.03 to 4.59; P=0.04), a history of atherosclerosis (HR, 2.48; 95% CI, 1.32 to 4.66; P<0.01), in-hospital renal failure (HR, 2.55; 95% CI, 1.15 to 5.63; P=0.02), pleural effusion on chest radiograph (HR, 2.56; 95% CI, 1.18 to 5.58; P=0.02), and in-hospital hypotension/shock (HR, 12.5; 95% CI, 3.24 to 48.21; P<0.01). Contemporary follow-up mortality in patients who survive to hospital discharge with acute type B aortic dissection is high, approaching 1 in every 4 patients at 3 years. Current treatment and follow-up surveillance require further study to better understand and optimize care for patients with this complex disease.