Abstract 18293: Predicting In-Hospital Mortality in Acute Type B Aortic Dissection: Evidences From IRAD

Abstract

Introduction: The outcome of acute type B aortic dissection (ABAD) patients is strongly related to the clinical presentation. The purpose of this study was to investigate predictors for mortality among patients presenting 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: All ABAD patients enrolled in IRAD between 1996 and 2013 were included for analysis. Multivariate 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. Results: A total of 1034 ABAD patients were included for analysis (673 male; mean age 63.5 ± 14.0), with an overall in-hospital mortality of 10.4%. In multivariate analysis, the following variables at admission were independently associated with increased in-hospital mortality: increasing age (OR 1.03, 95%CI 1.00-1.06, p=.044), hypotension/shock (OR 6.43, 95%CI 2.88-18.98), periaortic hematoma (OR 3.06, 95%CI 1.38-6.78, p=.006), descending diameter >5.5cm, (OR 6.04, 95%CI 2.87-12.73, p<.001), mesenteric ischemia (OR 9.03, 95%CI 3.49-23.38, p<.001), acute renal failure (OR 3.61, 95%CI 1.68-7.75) and limb ischemia (OR 3.02, 95%CI 1.05-8.68, p=.040). Based on these multivariate results, a reliable and simple bedside risk prediction tool was developed. Conclusion: The clinical presentation of ABAD is heterogeneous and strongly predicts in-hospital outcome. We present a simple prediction model using variables that are independently associated with in-hospital mortality in ABAD patients. This model could be used to assist physicians in their choice of management and for informing patients and their families.