title: Determinants of in-hospital death and rupture in patients with a Stanford B aortic dissection.
abstract: BACKGROUND
  In Stanford B acute aortic dissection (AAD), medical treatment is the choice of therapy in the acute phase, however, a portion of patients experience complications caused by serious clinical outcomes including aortic rupture and abdominal visceral ischemia. The objective of this study was to determine the predictors of in-hospital events in an Asian cohort of Stanford type B AAD.
  
  
  RESULTS
  Hospital records were queried to identify patients that met following criteria: (1) AAD presenting within 14 days of symptom onset; and (2) computed tomography (CT) confirmation of a dissected descending aorta not involving the ascending aorta. An in-hospital event was defined as death, rupture/impending rupture, or organ malperfusion. Patient characteristics, inflammatory markers, and CT findings were obtained from clinical case records and retrospectively analyzed. Two hundred and twenty patients with Stanford B AAD were identified. In-hospital events occurred in 15 patients (there were 8 deaths, and 5 patients need to undergo emergent surgery because of impending rupture or rupture, and 4 patients experienced organ malperfusion). In univariate logistic regression analysis, the non-thrombosed type (odds ratio (OR) 3.88, 95% confidence interval (CI) 1.20-12.61, p=0.02) and maximum aortic diameter measured by an initial CT (each having a 5 mm increment: OR 1.61, 95% CI 1.20-2.15, p=0.001) were significant predictors of in-hospital events. In multiple logistic regression analysis, the only significant predictor was maximum aortic diameter measured by an initial CT (each having a 5 mm increment: OR 1.41, 95% CI 1.04-1.92, p=0.03).
  
  
  CONCLUSIONS
  The results identified a large maximum aortic diameter as the independent predictor of in-hospital events in Stanford type B AAD. The non-thrombosed type might also help differentiate high-risk patients.
authors: Division of Cardiovascular Medicine, Department of Integrated Medicine I, Jichi Medical University, Omiya Medical Center, Omiya, Japan.
authors: Kenichi
authors: K
authors: Sakakura
authors: Norifumi
authors: N
authors: Kubo
authors: Junya
authors: J
authors: Ako
authors: Nahoko
authors: N
authors: Ikeda
authors: Hiroshi
authors: H
authors: Funayama
authors: Taishi
authors: T
authors: Hirahara
authors: Yoshitaka
authors: Y
authors: Sugawara
authors: Takanori
authors: T
authors: Yasu
authors: Masanobu
authors: M
authors: Kawakami
authors: Shinichi
authors: S
authors: Momomura
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000097:blood / Q000401:mortality* / Q000473:pathology; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000473:pathology; D001014:Aortic Aneurysm / Q000097:blood / Q000401:mortality* / Q000473:pathology; D001019:Aortic Rupture / Q000097:blood / Q000401:mortality* / Q000473:pathology; D001416:Back Pain / Q000175:diagnosis; D002097:C-Reactive Protein / Q000378:metabolism; D002637:Chest Pain / Q000175:diagnosis; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D007958:Leukocyte Count; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D002097:C-Reactive Protein