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Outlook Commentary

University of Pittsburgh

^* To whom correspondence should be addressed. E-mail: chojs{at}upmc.edu.

	Abstract

Abstract 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 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 = .61). Independent predictors of follow-up mortality included female gender (hazard ratio [HR], 1.99; 95% confidence interval [CI], 1.07-3.71; P = .03), a history of prior aortic aneurysm (HR, 2.17; 95% CI, 1.03-4.59; P = .04), a history of atherosclerosis (HR, 2.48; 95% CI, 1.32-4.66; P < .01), in-hospital renal failure (HR, 2.55; 95% CI, 1.15-5.63; P = .02), pleural effusion on chest radiograph (HR, 2.56; 95% CI, 1.18-5.58; P = .02), and in-hospital hypotension/ shock (HR, 12.5; 95% CI, 3.24-48.21; 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.

First published on April 2, 2008, doi:10.1177/1531003507310832

Perspectives in Vascular Surgery and Endovascular Therapy 2008;20:95.

A more recent version of this article appeared on March 1, 2008


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