Angiotensin-converting enzyme inhibitors reduce long-term aortic events in patients with acute type B aortic dissection.
BACKGROUND
Medical therapy gives excellent short-term outcomes for patients with Stanford type B acute aortic dissection. However, the affected aorta is often compromised by aneurysmal dilatation and rupture, resulting in poor long-term outcome. The present study investigated which antihypertensive treatment may prevent long-term aortic events in these patients.


RESULTS
The study group comprised 78 consecutive patients with Stanford type B acute aortic dissection who were treated medically and followed-up for an average of 873+/-548 days. The optimal hypertensive drug regimen to reduce aortic events was determined by multivariate analyses. Of the 78 patients, 73 (94%) were discharged from hospital with medical therapy, and aortic events occurred in 13 (18%) of them (aortic rupture/recurrent dissection in 2 (3%); aortic expansion >or=60 mm in 7 (10%), rapid aortic expansion >or=10 mm/year in 3 (4%), and development of visceral/limb ischemia in 1 (1%)) during follow-up. By multivariate analysis, patients given angiotensin-converting enzyme inhibitor (ACEI) were less likely to have long-term aortic events than those without (odds ratio: 0.18, 95% confidence interval: 0.04-0.85).


CONCLUSIONS
Use of ACEI is associated with a reduced risk of long-term aortic events in patients with medically treated type B aortic dissection.
Takeshita
Satoshi
S
Department of Cardiology, National Cardiovascular Center, Suita, Japan. stake@muse.ocn.ne.jp
Sakamoto
Shingo
S
Kitada
Shuichi
S
Akutsu
Koichi
K
Hashimoto
Hideki
H
D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D001019:Aortic Rupture / Q000401:mortality* / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D013997:Time Factors
D000806:Angiotensin-Converting Enzyme Inhibitors