Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland.
Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
Eur J Cardiothorac Surg. 2022 Oct 4;62(5). doi: 10.1093/ejcts/ezac495.
Single-center retrospective cohort study to evaluate the impact of oral anticoagulation (OAC) on long-term outcomes of conservatively managed acute type B aortic dissection.
Clinical and morphological data of eligible patients from a high-volume vascular centre from 1 January 2003 through 31 December 2020 were evaluated. Patients were excluded for: type A or non-A-non-B dissection, isolated abdominal dissection, intramural haematoma and connective tissue disease. The primary outcome was freedom from late aortic events (intervention, rupture and mortality). Secondary outcomes included spinal cord ischaemia, bleeding, reno-visceral artery occlusion, ilio-femoral intervention, dissection propagation, aortic growth, aortic remodelling, deterioration of false lumen thrombosis as well as 30-day and overall mortality. Time to event was analysed using multivariable Cox proportional hazard models with OAC as time-varying covariate and mortality as a competing risk. The impact of OAC was adjusted for potential confounding factors.
A total of 69 patients [50 males, median age 65 (interquartile range: 58-72) years] were enrolled. The median follow-up was 49.3 (28-92) months. A total of 47 patients (68%) received OAC at any time throughout the follow-up for a median length of 26 (11-61) months. Late aortic events occurred in 28 patients (41%) including intervention (n = 27, 39%) and rupture (n = 1, 1%). OAC was associated with more late aortic events (hazard ratio 3.94, 95% confidence interval 1.06-14.6, P = 0.040). Secondary outcomes were not associated with OAC.
Our data suggest a relation of OAC therapy with an increased risk for late aortic interventions. Type B aortic dissection should not be the primary indication for OAC and patients with OAC for other indications require frequent follow-up imaging.
单中心回顾性队列研究，评估口服抗凝治疗（OAC）对保守治疗的急性 B 型主动脉夹层患者长期预后的影响。
评估了 2003 年 1 月 1 日至 2020 年 12 月 31 日期间来自一家大容量血管中心的符合条件的患者的临床和形态学数据。排除标准为：A型或非 A 非 B 型夹层、孤立性腹主动脉夹层、壁内血肿和结缔组织疾病。主要结局是无晚期主动脉事件（介入、破裂和死亡）。次要结局包括脊髓缺血、出血、肾-内脏动脉闭塞、髂股动脉介入、夹层扩展、主动脉生长、主动脉重塑、假腔血栓恶化以及 30 天和总体死亡率。采用多变量 Cox 比例风险模型分析时间事件，OAC 作为时变协变量，死亡作为竞争风险。调整 OAC 对潜在混杂因素的影响。
共纳入 69 例患者[50 例男性，中位年龄 65 岁（四分位间距：58-72 岁）]。中位随访时间为 49.3 个月（28-92 个月）。共有 47 例患者（68%）在整个随访期间的任何时间接受 OAC 治疗，中位时间为 26 个月（11-61 个月）。28 例患者（41%）发生晚期主动脉事件，包括介入（n=27，39%）和破裂（n=1，1%）。OAC 与更多的晚期主动脉事件相关（风险比 3.94，95%置信区间 1.06-14.6，P=0.040）。次要结局与 OAC 无关。
我们的数据表明，OAC 治疗与晚期主动脉介入风险增加有关。B 型主动脉夹层不应作为 OAC 的主要适应证，而其他适应证接受 OAC 治疗的患者需要频繁进行随访影像学检查。
