BACKGROUND - Earlier studies evaluating long-term survival in type A acute aortic dissection (TA-AAD) have been restricted to a small number of patients in single center experiences. We used data from a contemporary, multi-center international registry of TA-AAD patients to better understand factors associated with long-term survival. METHODS AND RESULTS - We examined 303 consecutive patients with TA-AAD enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and 2003. We included patients who were discharged alive and had documented clinical follow-up data. Kaplan-Meier survival curves were constructed to depict cumulative survival in patients from date of hospital discharge. Stepwise Cox proportional hazards analysis was performed to identify independent predictors of follow-up mortality. We found that 273 (90.1%) patients had been managed surgically and 30 (9.9%) were managed medically. Patients who were dead at follow-up were more likely to be older (63.9 versus 58.4 years, P=0.007) and to have had previous cardiac surgery (23.9% versus 10.6%, P=0.01). Survival for patients treated with surgery was 96.1%±2.4% and 90.5%±3.9% at 1 and 3 years versus 88.6%±12.2% and 68.7%±19.8% without surgery (mean follow-up overall, 2.8 years, log rank P=0.009). Multivariate analysis identified a history of atherosclerosis (relative risk (RR), 2.17; 95% confidence interval [CI], 1.08 to 4.37; P=0.03) and previous cardiac surgery (RR, 2.54; 95% CI, 1.16 to 5.57; P=0.02) as significant, independent predictors of follow-up mortality. CONCLUSIONS - Contemporary 1- and 3-year survival in patients with TA-AAD treated surgically are excellent. Independent predictors of survival during the follow-up period do not appear to be influenced by in-hospital risks but rather preexisting comorbidities.
|Titolo:||Long-term survival in patients presenting with type A acute aortic dissection : insights from the International Registry of Acute Aortic Dissection (IRAD)|
|Parole Chiave:||Aorta; Mortality; Risk factors; Surgery; Acute Disease; Age Factors; Aged; Aneurysm, Dissecting; Antihypertensive Agents; Aortic Aneurysm; Atherosclerosis; Cardiac Surgical Procedures; Cardiovascular Agents; Case Management; Comorbidity; Europe; Female; Follow-Up Studies; Humans; Hypertension; Japan; Life Tables; Male; Middle Aged; Mortality; Patient Discharge; Postoperative Complications; Proportional Hazards Models; Registries; Risk Factors; Survival Analysis; Treatment Outcome; United States; Physiology; Cardiology and Cardiovascular Medicine|
|Settore Scientifico Disciplinare:||Settore MED/23 - Chirurgia Cardiaca|
Settore MED/22 - Chirurgia Vascolare
|Data di pubblicazione:||lug-2006|
|Digital Object Identifier (DOI):||10.1161/CIRCULATIONAHA.105.000497|
|Appare nelle tipologie:||01 - Articolo su periodico|