Fattori Rossella, Tsai Thomas T, Myrmel Truls, Evangelista Arturo, Cooper Jeanna V, Trimarchi Santi, Li Jin, Lovato Luigi, Kische Stephan, Eagle Kim A, Isselbacher Eric M, Nienaber Christoph A
University Hospital S. Orsola, Bologna, Italy.
JACC Cardiovasc Interv. 2008 Aug;1(4):395-402. doi: 10.1016/j.jcin.2008.04.009.
Impact on survival of different treatment strategies was analyzed in 571 patients with acute type B aortic dissection enrolled from 1996 to 2005 in the International Registry of Acute Aortic Dissection.
The optimal treatment for acute type B dissection is still a matter of debate.
Information on 290 clinical variables were compared, including demographics; medical history; clinical presentation; physical findings; imaging studies; details of medical, surgical, and endovascular management; in-hospital clinical events; and in-hospital mortality.
Of the 571 patients with acute type B aortic dissection, 390 (68.3%) were treated medically, 59 (10.3%) with standard open surgery and 66 (11.6%) with an endovascular approach. Patients who underwent emergency endovascular or open surgery were younger (mean age 58.8 years, p < 0.001) than their counterparts treated conservatively, and had male preponderance and hypertension in 76.9%. Patients submitted to surgery presented with a wider aortic diameter than patients treated by interventional techniques or by medical therapy (5.36 +/- 1.7 cm vs. 4.62 +/- 1.4 cm vs. 4.47 +/- 1.4 cm, p = 0.003). In-hospital complications occurred in 20% of patients subjected to endovascular technique and in 40% of patients after open surgical repair. In-hospital mortality was significantly higher after open surgery (33.9%) than after endovascular treatment (10.6%, p = 0.002). After propensity and multivariable adjustment, open surgical repair was associated with an independent increased risk of in-hospital mortality (odds ratio: 3.41, 95% confidence interval: 1.00 to 11.67, p = 0.05).
In the International Registry of Acute Aortic Dissection, the less invasive nature of endovascular treatment seems to provide better in-hospital survival in patients with acute type B dissection; larger randomized trials or comprehensive registries are needed to access impact on outcomes.
分析1996年至2005年纳入国际急性主动脉夹层注册研究的571例急性B型主动脉夹层患者中不同治疗策略对生存的影响。
急性B型夹层的最佳治疗方法仍存在争议。
比较了290项临床变量的信息，包括人口统计学；病史；临床表现；体格检查结果；影像学检查；药物、手术和血管内治疗的细节；住院临床事件；以及住院死亡率。
在571例急性B型主动脉夹层患者中，390例（68.3%）接受药物治疗，59例（10.3%）接受标准开放手术，66例（11.6%）接受血管内治疗。接受急诊血管内或开放手术的患者比接受保守治疗的患者更年轻（平均年龄58.8岁，p<0.001），男性占优势，76.9%患有高血压。接受手术的患者主动脉直径比接受介入技术或药物治疗的患者更宽（5.36±1.7cm对4.62±1.4cm对4.47±1.4cm，p=0.003）。20%接受血管内技术治疗的患者和40%接受开放手术修复的患者发生了住院并发症。开放手术后的住院死亡率显著高于血管内治疗后（33.9%对10.6%，p=0.002）。经过倾向和多变量调整后，开放手术修复与住院死亡率独立增加的风险相关（优势比：3.41，95%置信区间：1.00至11.67，p=0.05）。
在国际急性主动脉夹层注册研究中，血管内治疗的微创性似乎为急性B型夹层患者提供了更好的住院生存率；需要更大规模的随机试验或综合注册研究来评估对结局的影响。
