Abstract 2678: Elevated level of Fibrinogen/Fibrin Degradation Product (FDP) is an Independent Predictor for Late Aortic Events in Patients with Acute Type B Aortic Dissection
Background: Previous studies have indicated that medical therapy provides an excellent outcome for patients with uncomplicated Stanford type B acute aortic dissection. During the follow-up, however, affected aortas can be often compromised by aneurysmal dilatation or rupture, resulting in poor long-term outcome. The purpose of this study was to determine the predictors of late aortic events in patients with Stanford type B acute aortic dissection receiving conservative medical therapy.
Methods: The study cohort consisted of 79 patients with Stanford type B acute aortic dissection who were admitted to the hospital within 48 hours from the onset. These patients were treated medically, and followed up for a mean duration of 30±21.8 months. To determine the predictors of late aortic events (rupture, recurrence of dissection, expansion of the aorta ≥60 mm in diameter, rapid aortic expansion at a rate of >10 mm/year in diameter, and development of visceral or limb ischemia), the baseline clinical characteristics were evaluated by univariate and multivariate analyses.
Results: During the follow-up, aortic events were observed in 18 patients (22.8%), which included aortic rupture in 4 (5%), recurrent dissection in 1 (1%), aortic diameter ≥ 60 mm in 7 (10%), rapid expansion of the dissected aorta in 3 (4%), and development of visceral or limb ischemia in 3 (4%). The cumulative event-free survival rate at 2 and 5 years were 81.0 % and 77.2%, respectively. When compared with patients without aortic events, those with aortic events were more frequently associated with FDP values of ≥20 μg/ml (p<0.001), a maximum aortic diameter of ≥40 mm (p=0.002), peak CRP values of ≥15 mg/dL (p=0.005), and true aortic aneurysms (p=0.008). By multivariate analysis, FDP ≥20 μg/ml at the time of admission was found to be an independent predictor of late aortic events (p=0.009, OR: 9.583, 95% CI: 1.758 –52.231).
Conclusions: These data demonstrate that FDP can be used as a predictor of late aortic events in patients with medically treated Stanford type B acute aortic dissection. Careful long-term monitoring may be required for patients with FDP elevation of ≥20 μg/ml at the time of admission.