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Dissección aórtica recurrente: observaciones del Registro Internacional de Dissección aórtica

Eric M Isselbacher¹, Marc P Bonaca¹, Marco Di Eusanio¹

¹From Thoracic Aortic Center (E.M.I., M.A., M.E.L.), Cardiology Division, Department of Medicine (E.M.I., M.E.L.), Cardiovascular Research Center (M.A., M.E.L.), and Pediatric Cardiology Division, Department of Pediatrics (M.E.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Cardiology Division, Boston, MA (M.P.B.); Cardiac Surgery Department, University Hospital S. Orsola, Bologna, Italy (M.D.E.); Cardiovascular Center (J.F., D.M., K.E.) and Cardiac Surgery (H.P.), University of Michigan, Ann Arbor; Cardiology Division, University of Salerno, Salerno, Italy (E.B.); Department of Cardiology, Robert Bosch Hospital, Stuttgart, Germany (U.S.); Departments of Medicine and Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.P.); Division of Cardiothoracic Surgery, Cedars-Sinai Med Center, Los Angeles, CA (A.K.); Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany (H.-H.E.); Hopital Bichat, Université Paris, Paris, France (G.J.); Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia (F.R.); and Royal Brompton & Harefield NHS Trust, Cardiology and Aortic Centre, London, UK (C.A.N.).

|September 3, 2016

Resumen

La disección aórtica recurrente (DA) es más común en pacientes con síndrome de Marfan. Esta condición aumenta significativamente el riesgo de un segundo evento de EA, lo que pone de relieve la necesidad de estrategias de vigilancia y gestión específicas.

Área de la Ciencia:

Medicina cardiovascular
La genética
Las bases de datos médicas

Sus antecedentes:

La mejora de la supervivencia después de la disección aórtica inicial (DA) conduce a una creciente población en riesgo de DA recurrente.
Los estudios previos sobre la EA recurrente estaban limitados por el pequeño tamaño de las muestras y los datos de una sola institución.
La base de datos del Registro Internacional de Dissección Aórtica Aguda (IRAD) proporciona una plataforma sólida para el estudio de la EA recurrente.

Objetivo del estudio:

Examinar los perfiles clínicos y los resultados de los pacientes con EA recurrente.
Comparar las características y los factores de riesgo de la EA recurrente con la EA inicial.
Identificar los factores predictivos de la enfermedad de Alzheimer recurrente y la mortalidad asociada.

Principales métodos:

Análisis de 204 pacientes con EA recurrente de la base de datos IRAD.
Comparación de pacientes con EA recurrente con 3624 pacientes con EA inicial.
Modelado de regresión logística y de Cox para identificar variables asociadas y predictores de supervivencia.

Principales resultados:

Los pacientes con EA recurrente presentaron tasas más altas de síndrome de Marfan (21,5% frente a 3,1%) y dimensiones aórticas más grandes.
El síndrome de Marfan fue un predictor independiente de la enfermedad de Alzheimer recurrente (HR, 8.6).
Los pacientes con EA recurrente con disección proximal y luego distal eran más jóvenes.

Conclusiones:

Aproximadamente el 5% de los pacientes con disección aórtica aguda tienen antecedentes de disección previa.
La EA recurrente está fuertemente asociada con el síndrome de Marfan.
Comprender los factores de riesgo como el síndrome de Marfan es crucial para manejar la disección aórtica recurrente.

Palabras clave:

Síndrome de Marfan la aorta Aneurisma de la aorta

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