BACKGROUND - 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. METHODS AND RESULTS - 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). CONCLUSIONS - 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.
|Titolo:||Long-term survival in patients presenting with type B acute aortic dissection : insights from the international registry of acute aortic dissection|
|Parole Chiave:||Aorta; Follow-up studies; Mortality; Risk factors; Acute Disease; Aged; Aneurysm, Dissecting; Aortic Aneurysm; Embolization, Therapeutic; Female; Follow-Up Studies; Hospitalization; Humans; Hypotension; Kaplan-Meier Estimate; Male; Medical Records; Middle Aged; Pleural Effusion; Proportional Hazards Models; Registries; Renal Insufficiency; Sex Factors; Shock; Treatment Outcome; Vascular Surgical Procedures; Physiology; Cardiology and Cardiovascular Medicine|
|Settore Scientifico Disciplinare:||Settore MED/22 - Chirurgia Vascolare|
|Data di pubblicazione:||nov-2006|
|Enti collegati al convegno:||American Heart Association|
|Digital Object Identifier (DOI):||10.1161/CIRCULATIONAHA.106.622340|
|Appare nelle tipologie:||01 - Articolo su periodico|