Recurrent Aortic Dissection: Observations from the International Registry of Aortic Dissection (IRAD)
Background—Improved medical care after initial aortic dissection (AD) has led to increased survivorship and a population of individuals at risk for further cardiovascular events, including recurrent AD. Reports describing recurrent ADs have been restricted to small numbers of patients from single institutions. We used the International Registry of Acute Aortic Dissection (IRAD) database to examine the clinical profiles and outcomes of patients with recurrent AD.
Methods—We identified 204 patients enrolled in IRAD with recurrent AD. For the primary analysis, patient characteristics, interventions, and outcomes were analyzed and compared to 3624 patients with initial AD. Iterative logistic modeling was performed to investigate variables associated with recurrent AD. Cox regression analyses were used to determine variables associated with 5-year survival. A subset of recurrent AD patients was analyzed for anatomic and demographic details of initial and recurrent ADs.
Results—Patients with recurrent AD were more likely to have Marfan syndrome (MFS) (21.5% vs. 3.1%, p<0.001), but not bicuspid aortic valve (BAV) (3.6% vs. 3.2%, p=0.77). Descending aortic dimensions were greater in recurrent AD patients than initial AD patients independent of sentinel dissection type (type A, 4.3 cm [3.5-5.6] vs. 3.3 cm [2.9-3.7], p<0.001; type B, 5.0 cm [3.9-6.0] vs. 4.0 cm [3.5-4.8], p<0.001) and this observation was accentuated among MFS patients. In multivariate analysis, the diagnosis of MFS independently predicted recurrent AD (Hazard Ratio (HR) [8.6], 95% confidence interval (CI) [5.8-12.8], p<0.001). Recurrent AD patients who presented with proximal followed by distal AD were younger than patients who experienced distal followed by proximal dissection AD (42.1 ± 16.1 years vs. 54.3 ± 14.8 years, p=0.004).
Conclusions—Among those suffering acute aortic dissection, 5% have a history of a prior aortic dissection. Recurrent AD is strongly associated with MFS.
- Received September 4, 2015.
- Revision received August 2, 2016.
- Accepted August 23, 2016.