Factors related to long-term prognosis in medically treated type B aortic dissection: a physical predisposing factor

In medically treated patients with Stanford type B aortic dissection, it has been shown that the state of the dissecting aorta in the acute phase predicts the prognosis. The present study examined other crucial factors, including physical characteristics, related to the long-term prognosis in type B aortic dissection.

Two hundred and two patients with type B aortic dissection who were discharged alive with medical treatment in the acute phase (mean age 66.5 years, range 29-90 years, 160 males) were followed.

During the mean follow-up period of 4.9 years (ranging up to 12.2 years), 37 all-cause deaths were confirmed. A surgical procedure related to aortic dissection was performed in 8, and re-dissection occurred in 3. The survival rate at 5 years after onset was 82%. On Cox regression analysis, increased height (greater than the median value) was significantly associated with all-cause death and the composite aortic event when adjusted by age and sex (hazard ratio [HR]=2.22, 95%confidence interval [CI] 1.15-4.83, P=0.021, and HR=4.53, 95%CI 1.26-16.35, P=0.021, respectively). Patients with coexisting true aortic aneurysms also had a higher risk than those without (composite aortic events, HR=3.63, 95%CI 1.41-9.35, P=0.008).

More strict management in the chronic phase is needed in taller patients as well as patients with coexisting true aortic aneurysms. This common physical predisposing feature may also assist in making the decision for earlier surgical intervention to the affected aorta.