Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy; University College London Institute for Cardiovascular Science and Barts Heart Centre, St. Bartholomew's Hospital, London, UK.
Eur J Vasc Endovasc Surg. 2018 Aug;56(2):200-208. doi: 10.1016/j.ejvs.2018.03.030. Epub 2018 May 18.
The aim was to assess the long-term outcome of patients diagnosed with type A and type B acute aortic syndromes (AAS) and the mortality risk predictors.
A single centre retrospective observational study was performed on consecutive patients diagnosed with AAS and discharged between 2000 and 2016: 242 surgically treated type A, 87 uncomplicated, medically treated type B, and 80 complicated type B who received endovascular/surgical/hybrid treatment. Follow up of discharged patients (5 ± 3.9 years) was almost complete by the end of the study (December 2017).
The mean age was 65.3 ± 12.5 years, and 70.2% were men. Long-term all cause mortality was 5.4 per 100 patients per year in surgically treated type A AAS patients and 6.7 per 100 patients per year in type B AAS patients (p = .236). The rates of major aorta related events were 6.1 per 100 patients per year and 13.4 per 100 patients per year, respectively (p < .001). Non-aorta related events during long-term follow up occurred in 18.2 per 100 patients per year in type A and 13.8 per 100 patients per year in type B (p = .055). At the end of follow up 279/409 (68.2%) patients (165/242 type A and 114/167 type B) experienced at least one event.
Among patients with either type A or type B AAS surviving the acute phase, the risk of adverse aorta and non-aorta related events, including death, persists during follow up, so that eventually two thirds of patients will experience at least one event. Notably, all cause mortality after type B AAS exceeds that of type A AAS after three years.
本研究旨在评估急性主动脉综合征（AAS）A 型和 B 型患者的长期预后及死亡风险预测因素。
本研究为单中心回顾性观察性研究，纳入 2000 年至 2016 年期间连续诊断为 AAS 并出院的患者：242 例手术治疗的 A 型、87 例未经治疗的单纯 B 型和 80 例接受血管内/手术/杂交治疗的复杂 B 型。在研究结束时（2017 年 12 月），通过电话或病历随访几乎完成了所有出院患者（5±3.9 年）的随访。
患者平均年龄为 65.3±12.5 岁，70.2%为男性。手术治疗的 A 型 AAS 患者的长期全因死亡率为每年每 100 例患者 5.4 例，B 型 AAS 患者为每年每 100 例患者 6.7 例（p=.236）。每年每 100 例患者发生主动脉相关主要事件的发生率分别为 6.1 例和 13.4 例（p<0.001）。长期随访期间发生非主动脉相关事件的发生率分别为每年每 100 例患者 18.2 例和 13.8 例（p=0.055）。在随访结束时，409 例患者中有 279 例（68.2%）（242 例 A 型中的 165 例和 167 例 B 型中的 114 例）经历了至少一次事件。
在急性期中存活下来的 A 型或 B 型 AAS 患者，在随访期间仍有发生不良主动脉和非主动脉相关事件（包括死亡）的风险，因此最终三分之二的患者将经历至少一次事件。值得注意的是，B 型 AAS 后的全因死亡率超过了 A 型 AAS 后 3 年的死亡率。
