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Published on: May 21, 2017
Cardiovascular morbidity and mortality after aortic dissection, intramural hematoma, and penetrating aortic ulcer
Salome Weiss1, Indrani Sen2, Ying Huang2
1Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn; Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, Bern, Switzerland.
Insights
Patients with aortic dissection (AD), intramural hematoma (IMH), and penetrating aortic ulcers (PAU) face a significantly higher risk of cardiovascular death and events like heart failure. Long-term cardiovascular management is crucial for these individuals.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Epidemiology
Background:
- Aortic dissection (AD), intramural hematoma (IMH), and penetrating aortic ulcers (PAU) are serious aortic conditions.
- The long-term nonaortic cardiovascular (CV) risks associated with these conditions are not well-defined.
Purpose of the Study:
- To determine the rates of nonaortic cardiovascular morbidity and mortality in patients newly diagnosed with AD, IMH, and PAU.
- To compare the CV event rates in these patients against age- and sex-matched population referents.
Main Methods:
- Retrospective review of Olmsted County residents diagnosed with AD, IMH, or PAU between 1995 and 2015.
- Primary outcome: nonaortic CV death. Secondary outcome: first-time nonfatal CV event (myocardial infarction, heart failure, stroke).
- Cox proportional hazards regression was used for outcome comparison, adjusting for comorbidities.
Main Results:
- 133 patients (77 AD, 21 IMH, 35 PAU) were identified with a median follow-up of 10 years.
- Patients with AD/IMH/PAU showed a 2.4-fold increased risk of CV death and a 3.0-fold increased risk of nonfatal CV events, primarily heart failure.
- These increased risks persisted even when excluding early events, indicating a sustained higher risk.
Conclusions:
- Patients with AD, IMH, and PAU have a two- to threefold increased risk of nonaortic cardiovascular death, nonfatal CV events, and heart failure compared to the general population.
- These findings highlight the critical need for ongoing, long-term cardiovascular management strategies for individuals diagnosed with these aortic conditions.
Objective:
The nonaortic cardiovascular morbidity and mortality of patients with aortic dissection (AD), intramural hematoma (IMH), and penetrating aortic ulcer (PAU) is unknown. We aimed to define the rates of cardiovascular (CV) events in a cohort of patients with newly diagnosed AD, IMH, and PAU.
Methods:
We performed a retrospective review of all Olmsted County, Minnesota, residents diagnosed with AD, IMH, and PAU from 1995 to 2015. The primary outcome was nonaortic CV death. The secondary outcome was a first-time nonfatal CV event (myocardial infarction, heart failure [HF], or stroke). The outcomes were compared with age- and sex-matched population referents using Cox proportional hazards regression, with adjustment for comorbidities.
Results:
A total of 133 patients (77 with AD, 21 with IMH, 35 with PAU; 57% male) with a mean age of 71.8 ± 14.1 years were identified. The median follow-up was 10 years. Compared with the population referents, the patients with AD/IMH/PAU had an increased risk of CV death (adjusted hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.4-4.2; P = .003) and an increased risk of any first-time nonfatal CV event (adjusted HR, 3.0; 95% CI, 1.9-4.8; P < .001), mainly resulting from an increased risk of first-time HF (adjusted HR, 2.7; 95% CI, 1.7-4.3; P < .001). When excluding events within 14 days of the diagnosis, the patients with AD/IMH/PAU remained at increased risk of CV death (adjusted HR, 2.6; 95% CI, 1.4-4.7; P = .002), any first-time nonfatal CV event (adjusted HR, 2.6; 95% CI, 1.5-4.4, P <.001), and first-time HF (adjusted HR 2.5, 95% CI 1.5-4.3; P < .001).
Conclusions:
Compared with the population referents, the patients with AD/IMH/PAU had a two- to threefold risk of nonaortic CV death, any first-time nonfatal CV event, and first-time HF. These data implicate the need for long-term cardiovascular management for patients with AD/IMH/PAU.
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