Abstract 18518: Effect of Medical Treatment for Aortic Dissection on In-Hospital Mortality and Follow-Up Aortic Expansion in Patients with and Without Marfan Syndrome; Observations from the International Registry of Acute Aortic Dissection
Background: Medical management of acute aortic dissection (AAD) is poorly understood and based mainly on personal experience, expert opinion and observational studies. Society guidelines reaffirm this lack of evidence. We sought to determine the association of specific medications on outcomes in AAD patients.
Methods: Prior analyses from the International Registry of Acute Aortic Dissection (IRAD) suggest beta blockers (BB) are associated with lower long-term mortality after AAD, and calcium channel blockers (CCB) are associated with lower long-term mortality after type B AAD. For this abstract, we analyzed factors associated with in-hospital mortality and aortic growth at follow-up, including medication use, using IRAD. We also looked at medication use and long-term survival in AAD patients with Marfan Syndrome (MFS).
Results: Among 817 patients with type B AAD, improved in-hospital survival was associated with BB use (OR 23.09, 95% CI 6.62-80.58, p<0.001), absence of mesenteric ischemia (OR 10.53, 95% CI, 1.31-84.7, p=0.03) and absence of hypotension/shock (OR 7.55, 95% CI, 1.15-49.4, p=0.04). No benefit was associated with use of angiotensin converting enzyme inhibitor (ACE). On follow-up, CCB were associated with slower aortic growth in medically treated type B patients (p=0.013), and CCB use during the first two years after AAD is associated with negative growth of the aorta ( -0.07mm/yr for patients on CCB vs. 0.42mm/yr for those not, p=0.008). Analysis of 68 MFS patients showed improved long-term survival in type A patients receiving BB (p=0.01); ACE were associated with increased mortality after 30 months (p=0.008).
Conclusions: This analysis suggests BB are associated with improved in-hospital survival in AAD patients. CCB in Type B patients are associated with improved survival and slower descending aortic growth. MFS patients also benefited from BB use. RAS inhibitors were not associated with improved in-hospital or long-term survival in patients (including MFS patients) with AAD. Whether these observed associations between treatment and outcome are due to cause-and effect cannot be determined. Optimal management needs to be confirmed in randomized controlled trials.
- © 2012 by American Heart Association, Inc.