From Thoracic Aortic Center (E.M.I., M.A., M.E.L.), Cardiology Division, Department of Medicine (E.M.I., M.E.L.), Cardiovascular Research Center (M.A., M.E.L.), and Pediatric Cardiology Division, Department of Pediatrics (M.E.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Cardiology Division, Boston, MA (M.P.B.); Cardiac Surgery Department, University Hospital S. Orsola, Bologna, Italy (M.D.E.); Cardiovascular Center (J.F., D.M., K.E.) and Cardiac Surgery (H.P.), University of Michigan, Ann Arbor; Cardiology Division, University of Salerno, Salerno, Italy (E.B.); Department of Cardiology, Robert Bosch Hospital, Stuttgart, Germany (U.S.); Departments of Medicine and Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.P.); Division of Cardiothoracic Surgery, Cedars-Sinai Med Center, Los Angeles, CA (A.K.); Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany (H.-H.E.); Hopital Bichat, Université Paris, Paris, France (G.J.); Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia (F.R.); and Royal Brompton & Harefield NHS Trust, Cardiology and Aortic Centre, London, UK (C.A.N.).
Circulation. 2016 Oct 4;134(14):1013-1024. doi: 10.1161/CIRCULATIONAHA.115.019359. Epub 2016 Sep 1.
Improved medical care after initial aortic dissection (AD) has led to increased survivorship and a population of individuals at risk for further cardiovascular events, including recurrent AD. Reports describing recurrent ADs have been restricted to small numbers of patients from single institutions. We used the IRAD (International Registry of Acute Aortic Dissection) database to examine the clinical profiles and outcomes of patients with recurrent AD.
We identified 204 patients enrolled in IRAD with recurrent AD. For the primary analysis, patient characteristics, interventions, and outcomes were analyzed and compared with 3624 patients with initial AD. Iterative logistic modeling was performed to investigate variables associated with recurrent AD. Cox regression analyses were used to determine variables associated with 5-year survival. A subset of recurrent AD patients was analyzed for anatomic and demographic details of initial and recurrent ADs.
Patients with recurrent AD were more likely to have Marfan syndrome (21.5% versus 3.1%; P<0.001) but not bicuspid aortic valve (3.6% versus 3.2%; P=0.77). Descending aortic dimensions were greater in patients with recurrent AD than in patients with initial AD independently of sentinel dissection type (type A: 4.3 cm [3.5-5.6 cm] versus 3.3 cm [2.9-3.7 cm], P<0.001; type B: 5.0 cm [3.9-6.0 cm] versus 4.0 cm [3.5-4.8 cm], P<0.001), and this observation was accentuated among patients with Marfan syndrome. In multivariate analysis, the diagnosis of Marfan syndrome independently predicted recurrent AD (hazard ratio, 8.6; 95% confidence interval, 5.8-12.8; P<0.001). Patients with recurrent AD who presented with proximal followed by distal AD were younger than patients who experienced distal followed by proximal dissection AD (42.1±16.1 versus 54.3±14.8 years; P=0.004).
Among those suffering acute aortic dissection, 5% have a history of a prior aortic dissection. Recurrent AD is strongly associated with Marfan syndrome.
初始主动脉夹层（AD）后的医疗水平提高导致了生存人数的增加，以及发生进一步心血管事件（包括复发性 AD）的风险人群。描述复发性 AD 的报告仅限于来自单个机构的少数患者。我们使用 IRAD（急性主动脉夹层国际注册研究）数据库研究了复发性 AD 患者的临床特征和结局。
我们在 IRAD 中确定了 204 名患有复发性 AD 的患者。在主要分析中，分析了患者特征、干预措施和结局，并与 3624 名患有初始 AD 的患者进行了比较。迭代逻辑回归模型用于研究与复发性 AD 相关的变量。Cox 回归分析用于确定与 5 年生存率相关的变量。对复发性 AD 患者的亚组进行了初始和复发性 AD 的解剖和人口统计学细节分析。
复发性 AD 患者更可能患有马凡综合征（21.5% 比 3.1%；P<0.001），而非二叶式主动脉瓣（3.6% 比 3.2%；P=0.77）。复发性 AD 患者的降主动脉直径大于初始 AD 患者，与哨兵夹层类型无关（A型：4.3cm [3.5-5.6cm] 比 3.3cm [2.9-3.7cm]，P<0.001；B 型：5.0cm [3.9-6.0cm] 比 4.0cm [3.5-4.8cm]，P<0.001），并且这种观察在马凡综合征患者中更为明显。多变量分析显示，马凡综合征的诊断独立预测复发性 AD（风险比，8.6；95%置信区间，5.8-12.8；P<0.001）。先近端后远端 AD 表现的复发性 AD 患者比先远端后近端 AD 表现的患者年龄更小（42.1±16.1 岁比 54.3±14.8 岁；P=0.004）。
在患有急性主动脉夹层的患者中，有 5%的患者有既往主动脉夹层病史。复发性 AD 与马凡综合征密切相关。
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