Abstract 9165: Short and Long-Term Case Fatality of Thoracic Aortic Dissection: A Thirteen Year Statewide Study
Objectives. We examined in-hospital and long-term case fatality in patients aged ≥ 20 years admitted with a first-time diagnosis of thoracic aortic dissection (AoD) to all non-federal hospitals in New Jersey (NJ) between 1995 and 2007 using a statewide database.
Methods. The Myocardial Infarction Data Acquisition System (MIDAS) database was used to identify demographic characteristics, comorbidities and the presence of hypertension (HT) and diabetes mellitus (DM) among AoD patients. Deaths were ascertained by matching the MIDAS records to death information from NJ Death Registration Files.
Results. The 2,373 cases of AoD observed during the study period were categorized into four groups: DM alone (n=41), HT alone (n=1,499), both DM and HT (n=237), neither of the conditions (n=596). Mortality from the index admission was high in all groups: 16.9% died in hospital, 19.6% within 30 days, 30.4% within 1 year and 43.8% within 5 years (Figure 1A). Figures 1B, 1C and 1D show the survival probability among 4 groups using Kaplan-Meier estimates. After adjusting for all covariates in the model, important predictors of mortality among all AoD patients were prior history of: hypertension, chronic renal disease, atrial fibrillation and arrhythmia. Of those who were discharged alive, 16.2% died within 1 year and 32.4% died within 5 years. Approximately 64% of the post discharge deaths were due to a cardiovascular cause, mostly comprised of coronary heart disease (35.6%), aortic aneurysm or dissection (33.4%) and cerebrovascular disease (9.3%). The remaining 36% of the post discharge deaths were due to a non-cardiovascular cause such as cancer, COPD, and renal disease.
Conclusions. Thoracic aortic dissection patients, including a previously unstudied diabetic subgroup, have a poor five year prognosis. A majority of the post-discharge deaths were due to a cardiovascular cause and a significant proportion of those were due to recurrent aortic dissection.
- © 2011 by American Heart Association, Inc.