Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
Division of Cardiac Surgery, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
Eur Heart J. 2019 Aug 21;40(32):2727-2736. doi: 10.1093/eurheartj/ehz153.
To evaluate the acute and long-term prognosis of acute aortic syndrome (AAS) according to the disease entity [intramural haematoma (IMH) vs. aortic dissection (AD)] and the anatomical location (type A vs. B).
A total of 1012 patients [672 with AD and 340 with IMH (33.6%)] were enrolled between 1993 and 2015. Compared with AD patients, IMH patients were older and had higher frequency of female sex and distal aorta involvement. The overall crude in-hospital mortality of AAS was 8.6%; type A AD [15.0%; adjusted hazard ratio (aHR) 30.4; 95% confidence interval (CI) 8.62-107.3; P < 0.001], type A IMH (8.0%; aHR 4.85; 95% CI 1.29-18.2; P = 0.019), type B AD (5.0%; aHR 3.51; 95% CI 1.00-12.4; P = 0.051), and type B IMH [1.5%; aHR 1.00 (reference)]. During a median follow-up duration of 8.5 years (interquartile range: 4.0-13.5 years), AD (aHR 2.78; 95% CI 1.87-4.14; P < 0.001) and type A (aHR 2.28; 95% CI 1.45-3.58; P < 0.001) was associated with a higher risk of aortic death. After 90 days, a risk of aortic death was no longer associated with anatomical location (aHR 0.74; 95% CI 0.40-1.36; P = 0.33), but remained associated with disease entity (aHR 1.83; 95% CI 1.10-3.04; P = 0.02).
The clinical features, response to treatment strategy, and outcomes of IMH patients were distinct from those of AD patients. Both early and late survival was better for IMH than for AD. In addition to the anatomical location of AAS, the disease entity is an independent factor associated with both acute and long-term mortality in patients with AAS. Further investigation is necessary to confirm the prognostic implication of disease entity in different patient populations.
根据疾病实体（壁内血肿 [IMH] 与主动脉夹层 [AD]）和解剖部位（A型与 B 型）评估急性主动脉综合征（AAS）的急性和长期预后。
1993 年至 2015 年间共纳入 1012 例患者[AD 患者 672 例，IMH 患者 340 例（33.6%）]。与 AD 患者相比，IMH 患者年龄较大，女性和远端主动脉受累的频率更高。AAS 的总体住院死亡率为 8.6%；A型 AD[15.0%；调整后的危险比（aHR）30.4；95%置信区间（CI）8.62-107.3；P<0.001]、A型 IMH（8.0%；aHR 4.85；95%CI 1.29-18.2；P=0.019）、B 型 AD（5.0%；aHR 3.51；95%CI 1.00-12.4；P=0.051）和 B 型 IMH[1.5%；aHR 1.00（参考）]。在中位随访 8.5 年（四分位距：4.0-13.5 年）期间，AD（aHR 2.78；95%CI 1.87-4.14；P<0.001）和 A 型（aHR 2.28；95%CI 1.45-3.58；P<0.001）与更高的主动脉死亡风险相关。90 天后，主动脉死亡风险与解剖部位不再相关（aHR 0.74；95%CI 0.40-1.36；P=0.33），但仍与疾病实体相关（aHR 1.83；95%CI 1.10-3.04；P=0.02）。
IMH 患者的临床特征、对治疗策略的反应和结局与 AD 患者不同。与 AD 相比，IMH 的早期和晚期存活率均更好。除了 AAS 的解剖部位外，疾病实体也是与 AAS 患者急性和长期死亡率相关的独立因素。需要进一步研究以确认疾病实体在不同患者人群中的预后意义。
