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Post-Discharge Mortality in Patients with Type B Aortic Dissection

Partial thrombosis of the false lumen was associated with increased risk for death.

Patients with acute Type B aortic dissection, which involves the descending aorta, tend to have better in-hospital prognoses than those with Type A dissection, which involves the ascending aorta. However, post-discharge, the diagnosis of Type B dissection still carries a high risk for death. The prognostic importance of false-lumen patency has been documented; higher risk is associated with a patent false lumen than with complete thrombosis of the false lumen. These investigators used the International Registry of Acute Aortic Dissection (IRAD), a registry of patients from 22 aortic centers in 11 countries, to study the effect of partial thrombosis of the false lumen on outcomes of Type B aortic dissection.

Of 532 patients with type B dissections in the registry, the researchers analyzed the records of 201 (mean age, 61; 69% male) who had been discharged alive and for whom mortality data and complete imaging information, including consensus on patency status of the false lumen, were available. The median follow-up period was 2.8 years.

Overall, 25% of patients died within 3 years of hospital discharge. In multivariable analysis, the highest risk for death was found in patients with partial thrombosis of the lumen, compared with a patent false lumen (hazard ratio, 2.7; 95% confidence interval, 1.45–4.98). No significant difference in risk for death was found between patients with a patent false lumen and those with a completely thrombosed lumen. Another important predictor of death was previous aortic aneurysm (HR 2.05; 95% CI, 1.07–3.93).

Comment: Type B aortic dissection is associated with a high risk for death after hospital discharge, particularly in patients with partial thrombosis of the false lumen. It remains to be seen whether surgical or percutaneous intervention can alter this natural history.

— Harlan M. Krumholz, MD, SM

Published in Journal Watch Cardiology July 25, 2007

Citation(s):

Tsai TT et al. for the International Registry of Acute Aortic Dissection. Partial thrombosis of the false lumen in patients with acute type B aortic dissection. N Engl J Med 2007 Jul 26; 357:349-59.

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