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Predictors of Intervention and Mortality in Uncomplicated Acute Type B Aortic Dissection
Study Questions:
What factors predict intervention and mortality among patients with uncomplicated acute type B aortic dissection (uATBAD)?
Methods:
Patients admitted with uATBAD at one center from 2000-2014 were analyzed retrospectively. Patient and computed tomographic angiography-based variables were evaluated as predictors of intervention or mortality using Kaplan-Meier and Cox models.
Results:
Among 294 patients admitted with uATBAD, 156 (53%) with available imaging were included. Mean follow-up was 3.7 years. Multivariable predictors of mortality included aortic diameter >44 mm (hazard ratio [HR], 8.6; p < 0.01), diabetes (HR, 6.7; p < 0.01), age (HR, 1.06/year; p < 0.01), history of stroke (HR, 5.4; p < 0.01), connective tissue disorder (HR, 2.3; p < 0.01), and syncope on admission (HR, 9.5; p = 0.04). No association between mortality and false lumen diameter was observed. Aortic diameter >44 mm was also associated with decreased intervention-free survival. Intervention rates for patients with aortic diameter >44 mm at 1, 5, and 10 years were 18.8%, 29.5%, and 50.3%, respectively, versus 4.8%, 13.3%, and 13.3% in the ≤44 mm group (p < 0.01).
Conclusions:
Aortic diameter >44 mm is a predictor of mortality and decreased intervention-free survival among patients with uATBAD.
Perspective:
These results suggest that patients with uATBAD and larger aortic diameters warrant more frequent imaging surveillance. Key evidence gaps that remain include optimal medical management to prevent growth and appropriate criteria for late procedural intervention. Although the authors imply that patients with aortic diameter >44 mm might derive benefit from earlier intervention, this assertion is not supported directly by the analysis. Indications for intervention were not standardized or included, and it is possible that some interventions were performed based on diameter alone.
Keywords: Angiography, Aorta, Connective Tissue Diseases, Diabetes Mellitus, Diagnostic Imaging, Dissection, Intervention Studies, Mortality, Tomography, X-Ray Computed, Stroke, Survival, Syncope
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