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Late outcome of patients with aortic dissection: study of a national database
Hsi-Yu Yu1, Yih-Sharng Chen, Shu-Chien Huang
1Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7 Chung-Shan South Road, Taipei 100, Taiwan, ROC.
Insights
Late aortic events are common following aortic dissection, increasing after four years. Young age is a risk factor for those receiving corrective treatment, while Marfan syndrome and male gender pose risks for the palliative group.
Area of Science:
- Cardiovascular Medicine
- Thoracic Surgery
- Epidemiology
Background:
- Late mortality and morbidity following aortic dissection have remained consistent over the past two decades.
- Understanding risk factors for late events is crucial for improving patient outcomes.
Purpose of the Study:
- To analyze the risk factors associated with late aortic events in patients diagnosed with aortic dissection.
- To investigate the long-term outcomes of different treatment modalities for aortic dissection.
Main Methods:
- A retrospective analysis of 5654 aortic dissection cases from 1996-2001 using National Health Insurance Databases.
- Investigated factors included age, gender, Marfan syndrome, and initial treatment (corrective surgery vs. palliative care).
- Late aortic events were defined as aneurysmal evolution requiring intervention or aortic death between 6 months and 6 years post-initial event.
Main Results:
- The incidence of aortic dissection was 43 per million population.
- Late aortic events occurred at an average rate of 2.48% per year, increasing significantly after the fourth year.
- Young age was a risk factor for late events in the corrective surgery group (RR 0.60-0.82 per decade); Marfan syndrome (RR 4.08-10.7) and male gender (RR 1.46-2.1) were risk factors in the palliative group.
Conclusions:
- Late aortic events are a significant concern for both corrective and palliative treatment groups, particularly after four years.
- Risk stratification for late events should consider age in the corrective group and Marfan syndrome and male gender in the palliative group.
Objectives:
The incidence of late mortality and morbidity of aortic dissection remained unchanged during the past 20 years. The present study was to analyze the risk factors of late events for patients with aortic dissection.
Methods:
A total of 5654 cases of aortic dissection (3871 males) were collected from the National Health Insurance Databases from 1996 to 2001. Age, gender, Marfan syndrome, and initial treatment modality were the main factors to be investigated. Corrective group was defined by surgical operation with cardiopulmonary bypass and palliative group for the remaining. Late aortic events were defined by late aneurysmal evolution of diseased aorta needing surgical intervention or death of aortic causes from 6 months to 6 years.
Results:
The incidence of aortic dissection was 43 per 1000000 population in our country. Corrective group accounted for 19.3% of them and palliative group for 80.7%. Marfan syndrome accounted for 1.5% of all cases (4.3% of corrective surgery group). The rate of freedom from mortality at 1, 6 months, and 6 years was 80.4+/-1.3, 69.0+/-1.5, and 56.5+/-2.9% for corrective group and 89.5+/-0.5, 78.4+/-0.6, and 46.1+/-1.35% for palliative group. Nearly half of the late mortalities were attributed to atherosclerosis-related conditions (cardiac, stroke, or aortic causes). The incidence of late aortic events was 2.48% per year on an average, comparable between corrective and palliative groups. This incidence increased since the fourth year after their initial episode. For corrective group, young age was a risk factor of late aortic events (relative risk of 0.60-0.82 per decade, P = 0.037). For palliative group, Marfan syndrome and male gender were risk factors of late aortic events (relative risk of 4.08-10.7, P < 0.001 in the former; relative risk of 1.46-2.1, P = 0.002 in the latter).
Conclusions:
Late aortic events were not uncommon for both corrective and palliative groups, and its incidence increased since the fourth year after their initial episodes. Young age for corrective group, Marfan syndrome and male gender for palliative group were risk factors of late aortic events.
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