Long-term survival in patients presenting with type A acute aortic dissection: insights from the International Registry of Acute Aortic Dissection (IRAD).
BACKGROUND
Earlier studies evaluating long-term survival in type A acute aortic dissection (TA-AAD) have been restricted to a small number of patients in single center experiences. We used data from a contemporary, multi-center international registry of TA-AAD patients to better understand factors associated with long-term survival.


RESULTS
We examined 303 consecutive patients with TA-AAD enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and 2003. We included patients who were discharged alive and had documented clinical follow-up data. Kaplan-Meier survival curves were constructed to depict cumulative survival in patients from date of hospital discharge. Stepwise Cox proportional hazards analysis was performed to identify independent predictors of follow-up mortality. We found that 273 (90.1%) patients had been managed surgically and 30 (9.9%) were managed medically. Patients who were dead at follow-up were more likely to be older (63.9 versus 58.4 years, P=0.007) and to have had previous cardiac surgery (23.9% versus 10.6%, P=0.01). Survival for patients treated with surgery was 96.1%+/-2.4% and 90.5%+/-3.9% at 1 and 3 years versus 88.6%+/-12.2% and 68.7%+/-19.8% without surgery (mean follow-up overall, 2.8 years, log rank P=0.009). Multivariate analysis identified a history of atherosclerosis (relative risk (RR), 2.17; 95% confidence interval [CI], 1.08 to 4.37; P=0.03) and previous cardiac surgery (RR, 2.54; 95% CI, 1.16 to 5.57; P=0.02) as significant, independent predictors of follow-up mortality.


CONCLUSIONS
Contemporary 1- and 3-year survival in patients with TA-AAD treated surgically are excellent. Independent predictors of survival during the follow-up period do not appear to be influenced by in-hospital risks but rather preexisting comorbidities.
Tsai
Thomas T
TT
University of Michigan Cardiovascular Center, 24 Frank Lloyd Wright Drive, Lobby A, Room 3201, P.O. Box 384, Ann Arbor, Michigan 48106-0384, USA. hsianshi@umich.edu
Evangelista
Arturo
A
Nienaber
Christoph A
CA
Trimarchi
Santi
S
Sechtem
Udo
U
Fattori
Rossella
R
Myrmel
Truls
T
Pape
Linda
L
Cooper
Jeanna V
JV
Smith
Dean E
DE
Fang
Jianming
J
Isselbacher
Eric
E
Eagle
Kim A
KA
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality* / Q000601:surgery; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001014:Aortic Aneurysm / Q000401:mortality* / Q000601:surgery; D050197:Atherosclerosis / Q000453:epidemiology; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data; D002317:Cardiovascular Agents / Q000627:therapeutic use; D019090:Case Management; D015897:Comorbidity; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D007564:Japan / Q000453:epidemiology; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010351:Patient Discharge; D011183:Postoperative Complications / Q000453:epidemiology; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D000959:Antihypertensive Agents; D002317:Cardiovascular Agents