Long-Term Risks of Stroke in Patients With Type A Aortic Dissection: A Nationwide Cohort Study

Background Patients with type A aortic dissection (TAAD) have a high short-term risk of stroke. However, whether patients with TAAD have an increased long-term risk of stroke is still undetermined, and our study aims to address this knowledge gap. Methods and Results A nationwide retrospective cohort study was conducted using Taiwan's National Health Insurance Research Database. We included patients with TAAD as well as age- and sex-matched aortic disease-free individuals between 2003 and 2016. Inverse probability of treatment weighting was performed to balance patient characteristics between the groups. The primary outcome was the development of stroke, regardless of subtype; the secondary outcomes were the risk of developing either ischemic or hemorrhagic stroke. The hazard ratios (HRs) of stroke were estimated using the Cox proportional hazards model. After inverse probability of treatment weighting, 3556 and 7023 patients were categorized into the TAAD and aortic disease-free cohorts, respectively. The mean follow-up period was 5.71 years. The HRs for overall, ischemic, and hemorrhagic strokes in the TAAD cohort were 3.01 (95% CI, 2.40-3.78), 3.18 (95% CI, 2.47-4.10), and 2.32 (95% CI, 1.58-3.41), respectively, compared with the aortic disease-free cohort. Consistent trends of higher stroke risk in patients with TAAD were revealed in the analyses stratified by age; sex; antiplatelet use; and history of hypertension, diabetes, or dyslipidemia. Conclusions Our study findings revealed that patients with TAAD had an increased long-term risk of both ischemic and hemorrhagic strokes. Further studies are warranted to establish optimal strategies for stroke prevention in these patients.