编辑推荐——B型主动脉夹层的管理趋势与治疗结果：来自国际主动脉夹层注册研究的报告
Editor's Choice - Trends in Management and Outcomes of Type B Aortic Dissection: A Report From the International Registry of Aortic Dissection.
作者信息
Trimarchi Santi, Gleason Tom G, Brinster Derek R, Bismuth Jean, Bossone Eduardo, Sundt Thoralf M, Montgomery Daniel G, Pai Chih-Wen, Bissacco Daniele, de Beaufort Hector W L, Bavaria Joseph E, Mussa Firas, Bekeredjian Raffi, Schermerhorn Marc, Pacini Davide, Myrmel Truls, Ouzounian Maral, Korach Amit, Chen Edward P, Coselli Joseph S, Eagle Kim A, Patel Himanshu J
机构信息
Department of Clinical and Community Sciences, University of Milan, Milan, Italy; Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milan, Italy.
Department of Surgery, Brigham & Women's Hospital, Boston, MA, USA.
出版信息
Eur J Vasc Endovasc Surg. 2023 Dec;66(6):775-782. doi: 10.1016/j.ejvs.2023.05.015. Epub 2023 May 16.
OBJECTIVE
To describe the trends in management and outcomes of patients with acute type B aortic dissection in the International Registry of Acute Aortic Dissection.
METHODS
From 1996 - 2022, 3 908 patients were divided into similar sized quartiles (T1, T2, T3, and T4). In hospital outcomes were analysed for each quartile. Survival rates following admission were compared using Kaplan-Meier analyses with Mantel-Cox Log rank tests.
RESULTS
Endovascular treatment increased from 19.1% in T1 to 37.2% in T4 (p < .001). Correspondingly, medical therapy decreased from 65.7% in T1 to 54.0% in T4 (p < .001), and open surgery from 14.8% in T1 to 7.0% in T4 (p < .001). In hospital mortality decreased in the overall cohort from 10.7% in T1 to 6.1% in T4 (p < .001), as well as in medically, endovascularly and surgically treated patients (p = .017, .033, and .011, respectively). Overall post-admission survival at three years increased (T1: 74.8% vs. T4: 77.3%; p = .006).
CONCLUSION
Considerable changes in the management of acute type B aortic dissection were observed over time, with a significant increase in the use of endovascular treatment and a corresponding reduction in open surgery and medical management. These changes were associated with a decreased overall in hospital and three year post-admission mortality rate among quartiles.
目的
描述国际急性主动脉夹层注册研究中急性B型主动脉夹层患者的管理趋势和预后。
方法
1996年至2022年期间，3908例患者被分为规模相似的四分位数组（T1、T2、T3和T4）。对每个四分位数组的院内预后进行分析。采用Kaplan-Meier分析和Mantel-Cox对数秩检验比较入院后的生存率。
结果
血管内治疗从T1组的19.1%增至T4组的37.2%（p <.001）。相应地，药物治疗从T1组的65.7%降至T4组的54.0%（p <.001），开放手术从T1组的14.8%降至T4组的7.0%（p <.001）。整个队列的院内死亡率从T1组的10.7%降至T4组的6.1%（p <.001），接受药物、血管内和手术治疗的患者死亡率也下降（分别为p =.017、.033和.011）。入院后三年的总体生存率有所提高（T1组：74.8% vs. T4组：77.3%；p =.006）。
结论
随着时间的推移，观察到急性B型主动脉夹层的管理发生了显著变化，血管内治疗的使用显著增加，开放手术和药物治疗相应减少。这些变化与各四分位数组的总体院内死亡率和入院后三年死亡率降低相关。
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