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(Circulation. 2006;114:2226-2231.)
© 2006 American Heart Association, Inc.

Health Services and Outcomes Research

Long-Term Survival in Patients Presenting With Type B Acute Aortic Dissection

Insights From the International Registry of Acute Aortic Dissection

Thomas T. Tsai, MD; Rossella Fattori, MD; Santi Trimarchi, MD; Eric Isselbacher, MD; Truls Myrmel, MD; Arturo Evangelista, MD; Stuart Hutchison, MD; Udo Sechtem, MD; Jeanna V. Cooper, MS; Dean E. Smith, PhD; Linda Pape, MD; James Froehlich, MD; Arun Raghupathy, MD; James L. Januzzi, MD; Kim A. Eagle, MD; Christoph A. Nienaber, MD, on behalf of the International Registry of Acute Aortic Dissection (IRAD)

From Department of Internal Medicine (T.T.T., J.V.C., D.E.S., J.F., A.R., K.A.E.), Division of Cardiology, University of Michigan Medical Center, Ann Arbor, Mich; University Hospital S. Orsola (R.F.), Bologna, Italy; Istituto Policlinico San Donato (S.T.), San Donato, Italy; University of Rostock (C.A.N.), Rostock, Germany; Tromsø University Hospital (T.M.), Tromsø, Norway; Hospital General Universitari Vall d’Hebron (A.E.), Barcelona, Spain; St. Michael’s Hospital (S.H.), Toronto, Ontario, Canada; Robert-Bosch Krankenhaus (U.S.), Stuttgart, Germany; University of Massachusetts Hospital (L.P.), Worcester, Mass; and Massachusetts General Hospital (J.L.J., E.I.), Boston, Mass.

Correspondence to Thomas T. Tsai, MD, University of Michigan Medical Center, 24 Frank Lloyd Wright Dr, Lobby A, Room #3201, PO Box 384, Ann Arbor, MI 48106-0384. E-mail hsianshi{at}umich.edu

Received February 22, 2006; revision received September 11, 2006; accepted September 13, 2006.

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.

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CLINICAL PERSPECTIVE

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