Predicting In-Hospital Mortality in Acute Type B Aortic Dissection

Abstract

S45T he morbidity and mortality of acute type B aortic dissection (ABAD) are strongly related to the clinical presentation. 1,2 In contrast to patients with ascending involvement, medical treatment is the preferred therapy in all uncomplicated type B dissection patients, because current randomized controlled trials have failed to demonstrate a beneficial outcome of prophylactic endovascular repair in the shortterm.3,4 Surgical and endovascular approaches are reserved for patients presenting with complications such as shock, periaortic bleeding, organ malperfusion, limb ischemia, and rapidly expanding false lumen. However, these procedures are still associated with high mortality rates between 20% and 30% for surgery and 10% and 20% for endovascular repair in the acute setting, especially in the elderly.3-5 Because of the various clinical features of ABAD, the progress and outcome of individual patients with ABAD admitted to the emergency department remain unpredictable.6-8 Therefore, more insights into the early prognosis of ABAD based on patient characteristics and presenting symptoms are needed to optimize treatment strategies and inform patients and their family. A Background-The outcome of patients with acute type B aortic dissection (ABAD) is strongly related to their clinical presentation. The purpose of this study was to investigate predictors for mortality among patients presenting with ABAD and to create a predictive model to estimate individual risk of in-hospital mortality using the International Registry of Acute Aortic Dissection (IRAD). Methods and Results-All patients with ABAD enrolled in IRAD between 1996 and 2013 were included for analysis.Multivariable logistic regression analysis was used to investigate predictors of in-hospital mortality. Significant risk factors for in-hospital death were used to develop a prediction model. A total of 1034 patients with ABAD were included for analysis (673 men; mean age, 63.5±14.0 years), with an overall in-hospital mortality of 10.6%. In multivariable analysis, the following variables at admission were independently associated with increased in-hospital mortality: increasing age (odds ratio

Endovascular Repair Compared With Medical Management of Patients With Uncomplicated Type B Acute Aortic Dissection

“…In our study, the early event rate in the TEVAR group was 10.3%, which was higher than that of the BMT group (4.5%), although the difference was not statistically significant. The early event rate in the BMT group was consistent with findings from previous studies (19,20 In previous studies, the early mortality rates in patients with type B aortic dissection treated with TEVAR range between 2.4% and 10.9% (8,14) and, in patients treated with BMT, the range has been between 0% and 10.6% (5,11,21,22 CTA imaging in this study. Consistent with an earlier report (23), SINE was a severe complication in the TEVAR group and was associated with substantial mortality The patients in the BMT group experienced more aortic-related adverse events than those treated with TEVAR (Figure 1), and this result was partially consistent with our earlier report (11).…”

False Lumen Status in Patients With Acute Aortic Dissection: A Systematic Review and Meta‐Analysis

“…Dissections confined to the ascending aorta (type A) exhibit worse in‐hospital survival rates than those involving the descending aorta (type B) 2. A report from the International Registry of Acute Aortic Dissection (IRAD) identified an in‐hospital surgical mortality rate of 30% in AAD type A patients and 13% in type B 2, 3. However, long‐term outcomes for AAD patients with type B dissection are not necessarily better than those having type A. Long‐term survival of surgically treated patients with type B AAD after discharge ranges from 56% to 96% at 1 year and from 48% to 83% at 5 years 4, 5, 6, 7, 8.…”

Effects of Gender Differences on Short-term Outcomes in Patients with Type B Aortic Dissection

“…Progression of the disease as well as evolving treatment paradigms have seen endovascular repair replace open surgery as the preferred treatment for complicated TBAD, but treatment specifics of TEVAR and medical management, as well as long-term outcomes, remain unclear 3,13–15 . Although management patterns have fluctuated over the past ten years, TBAD remains a morbid condition not only in the acute phase, but also in the chronic phase due to the risk of progression to aneurysmal degeneration, rupture, and even death 16,17 , Differences in overall characteristics and outcomes between males and females have not been well studied in the TBAD population, in contrast to the well-documented gender differences in those with thoracic aortic aneurysm 18,19 .…”