title: Long-term survival in patients presenting with type B acute aortic dissection: insights from the International Registry of Acute Aortic Dissection.
abstract: BACKGROUND
  Follow-up survival studies in patients with acute type B aortic dissection have been restricted to a small number of patients in single centers. We used data from a contemporary registry of acute type B aortic dissection to better understand factors associated with adverse long-term survival.
  
  
  RESULTS
  We examined 242 consecutive patients discharged alive with acute type B aortic dissection enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and 2003. Kaplan-Meier survival curves were constructed, and Cox proportional hazards analysis was performed to identify independent predictors of follow-up mortality. Three-year survival for patients treated medically, surgically, or with endovascular therapy was 77.6+/-6.6%, 82.8+/-18.9%, and 76.2+/-25.2%, respectively (median follow-up 2.3 years, log-rank P=0.61). Independent predictors of follow-up mortality included female gender (hazard ratio [HR],1.99; 95% confidence interval [CI], 1.07 to 3.71; P=0.03), a history of prior aortic aneurysm (HR, 2.17; 95% CI, 1.03 to 4.59; P=0.04), a history of atherosclerosis (HR, 2.48; 95% CI, 1.32 to 4.66; P<0.01), in-hospital renal failure (HR, 2.55; 95% CI, 1.15 to 5.63; P=0.02), pleural effusion on chest radiograph (HR, 2.56; 95% CI, 1.18 to 5.58; P=0.02), and in-hospital hypotension/shock (HR, 12.5; 95% CI, 3.24 to 48.21; P<0.01).
  
  
  CONCLUSIONS
  Contemporary follow-up mortality in patients who survive to hospital discharge with acute type B aortic dissection is high, approaching 1 in every 4 patients at 3 years. Current treatment and follow-up surveillance require further study to better understand and optimize care for patients with this complex disease.
authors.affiliation: Department of Internal Medicine, Division of Cardiology, University of Michigan Medical Center, Ann Arbor, MI 48106-0384, USA. hsianshi@umich.edu
authors.forename: Thomas T
authors.initials: TT
authors.lastname: Tsai
authors.forename: Rossella
authors.initials: R
authors.lastname: Fattori
authors.forename: Santi
authors.initials: S
authors.lastname: Trimarchi
authors.forename: Eric
authors.initials: E
authors.lastname: Isselbacher
authors.forename: Truls
authors.initials: T
authors.lastname: Myrmel
authors.forename: Arturo
authors.initials: A
authors.lastname: Evangelista
authors.forename: Stuart
authors.initials: S
authors.lastname: Hutchison
authors.forename: Udo
authors.initials: U
authors.lastname: Sechtem
authors.forename: Jeanna V
authors.initials: JV
authors.lastname: Cooper
authors.forename: Dean E
authors.initials: DE
authors.lastname: Smith
authors.forename: Linda
authors.initials: L
authors.lastname: Pape
authors.forename: James
authors.initials: J
authors.lastname: Froehlich
authors.forename: Arun
authors.initials: A
authors.lastname: Raghupathy
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality* / Q000628:therapy*; D001014:Aortic Aneurysm / Q000401:mortality* / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007022:Hypotension / Q000209:etiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010996:Pleural Effusion / Q000209:etiology; D016016:Proportional Hazards Models; D012042:Registries; D051437:Renal Insufficiency / Q000209:etiology; D012737:Sex Factors; D012769:Shock / Q000209:etiology; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects