Tsai Thomas T, Fattori Rossella, Trimarchi Santi, Isselbacher Eric, Myrmel Truls, Evangelista Arturo, Hutchison Stuart, Sechtem Udo, Cooper Jeanna V, Smith Dean E, Pape Linda, Froehlich James, Raghupathy Arun, Januzzi James L, Eagle Kim A, Nienaber Christoph A
Department of Internal Medicine, Division of Cardiology, University of Michigan Medical Center, Ann Arbor, MI 48106-0384, USA.
Circulation. 2006 Nov 21;114(21):2226-31. doi: 10.1161/CIRCULATIONAHA.106.622340. Epub 2006 Nov 13.
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.
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).
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.
急性B型主动脉夹层患者的随访生存研究仅限于少数单中心的患者。我们利用当代急性B型主动脉夹层登记处的数据，以更好地了解与长期不良生存相关的因素。
我们研究了1996年至2003年间纳入国际急性主动脉夹层登记处（IRAD）的242例急性B型主动脉夹层存活出院的连续患者。构建了Kaplan-Meier生存曲线，并进行Cox比例风险分析以确定随访死亡率的独立预测因素。接受药物治疗、手术治疗或血管内治疗的患者三年生存率分别为77.6±6.6%、82.8±18.9%和76.2±25.2%（中位随访2.3年，对数秩检验P=0.61）。随访死亡率的独立预测因素包括女性（风险比[HR]，1.99；95%置信区间[CI]，1.07至3.71；P=0.03）、既往主动脉瘤病史（HR，2.17；95%CI，1.03至4.59；P=0.04）、动脉粥样硬化病史（HR，2.48；95%CI，1.32至4.66；P<0.01）、住院期间肾衰竭（HR，2.55；95%CI，1.15至5.63；P=0.02）、胸部X线片显示胸腔积液（HR，2.56；95%CI，1.18至5.58；P=0.02）以及住院期间低血压/休克（HR，12.5；95%CI，3.24至48.21；P<0.01）。
急性B型主动脉夹层存活至出院的患者当代随访死亡率很高，3年时接近每4例患者中有1例。目前的治疗和随访监测需要进一步研究，以更好地了解并优化对这种复杂疾病患者的护理。
