Predictors of long-term outcomes in patients with medical treatment for acute aortic dissection

Abstract

Background: Although uncomplicated acute aortic dissection can be managed with aggressive medical therapy, long-term outcomes of patients with medical treatment for either type A or B dissection have not been fully investigated. This study was designed to evaluate outcomes and identify prognostic predictors in patients with medical treatment for acute aortic dissection. Methods and results: We examined 85 patients (60 males, mean age 67.8 years) with acute aortic dissection, which were either Stanford type A or B and followed conservatively for a median period of 6.7 months. To analyze adverse events (death or any aortic events requiring open surgery or endovascular intervention), Kaplan-Meier event-free curves with log-rank tests were performed (Figure 1). Significantly high event rates were observed in females (p=0.011), and in patients with ulcer-like projection (p=0.004). Moreover, patients with estimated glomerular filtration ratio (eGFR) below the median level of 65.6 mL/min/1.73m2 (p=0.009) and patients with type A acute aortic dissection (p=0.010) had high risk of adverse events. Cox proportional hazard models demonstrated that females (HR 4.93, 95% CI: 1.73-14.03, p=0.003), below the median eGFR (HR 5.14, 95% CI: 1.43-18.55, p=0.012), and the presence of ulcer-like projection (HR 3.24, 95% CI: 1.11-9.44, p=0.031) were strong predictors for adverse events; on the contrary, the Stanford classification was not significant after multivariate adjustments. ![Figure][1] Figure 1 Conclusions: Low levels of eGFR, females, and the presence of ulcer-like projection, but not the Stanford classification were predictive of long-term outcomes in patients with intensive medical treatment for acute aortic dissection. [1]: pending:yes