Partial thrombosis of the false lumen in patients with acute type B aortic dissection.
BACKGROUND
Patency or thrombosis of the false lumen in type B acute aortic dissection has been found to predict outcomes. The prognostic implications of partial thrombosis of the false lumen have not yet been elucidated.


METHODS
We examined 201 patients with type B acute aortic dissection who were enrolled in the International Registry of Acute Aortic Dissection between 1996 and 2003 and who survived to hospital discharge. Kaplan-Meier mortality curves were stratified according to the status of the false lumen (patent, partial thrombosis, or complete thrombosis) as determined during the index hospitalization. Cox proportional-hazards analysis was performed to identify independent predictors of death.


RESULTS
During the index hospitalization, 114 patients (56.7%) had a patent false lumen, 68 patients (33.8%) had partial thrombosis of the false lumen, and 19 (9.5%) had complete thrombosis of the false lumen. The mean (+/-SD) 3-year mortality rate for patients with a patent false lumen was 13.7+/-7.1%, for those with partial thrombosis was 31.6+/-12.4%, and for those with complete thrombosis was 22.6+/-22.6% (median follow-up, 2.8 years; P=0.003 by the log-rank test). Independent predictors of postdischarge mortality were partial thrombosis of the false lumen (relative risk, 2.69; 95% confidence interval [CI], 1.45 to 4.98; P=0.002), a history of aortic aneurysm (relative risk, 2.05; 95% CI, 1.07 to 3.93; P=0.03), and a history of atherosclerosis (relative risk, 1.87; 95% CI, 1.01 to 3.47; P=0.05).


CONCLUSIONS
Mortality is high after discharge from the hospital among patients with type B acute aortic dissection. Partial thrombosis of the false lumen, as compared with complete patency, is a significant independent predictor of postdischarge mortality in these patients.
Tsai
Thomas T
TT
Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, MI 48109-5853, USA. hsianshi@umich.edu
Evangelista
Arturo
A
Nienaber
Christoph A
CA
Myrmel
Truls
T
Meinhardt
Gabriel
G
Cooper
Jeanna V
JV
Smith
Dean E
DE
Suzuki
Toru
T
Fattori
Rossella
R
Llovet
Alfredo
A
Froehlich
James
J
Hutchison
Stuart
S
Distante
Alessandro
A
Sundt
Thoralf
T
Beckman
Joshua
J
Januzzi
James L
JL
Isselbacher
Eric M
EM
Eagle
Kim A
KA
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000784:Aortic Dissection / Q000150:complications* / Q000401:mortality; D001014:Aortic Aneurysm / Q000150:complications* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D012306:Risk; D013927:Thrombosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D014654:Vascular Patency