Clinical profiles and outcomes of acute type B aortic dissection in the current era: Lessons from the International Registry of Aortic Dissection (IRAD)
Clinical profiles and outcomes of acute type B aortic dissection in the current era: Lessons from the International Registry of Aortic Dissection (IRAD)
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DOI：
10.1161/01.cir.0000087386.07204.09
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发表时间：
2003-09-09
期刊：
影响因子：
37.8
通讯作者：
Nienaber, CA
中科院分区：
文献类型：
--
作者：
Suzuki, T;Mehta, RH;Nienaber, CA
方法和结果--因此，我们分析了384例(65+/-13岁，男性71%)急性B型主动脉夹层在国际急性主动脉夹层注册(IRAD)中登记的患者。大多数患者有高血压，并表现为急性胸/背痛。只有一半的患者在胸片上发现异常，几乎所有患者都进行了计算机断层扫描(CT)、经食道超声心动图、磁共振成像(MRI)和/或主动脉造影以确认诊断。住院死亡率为13%，大多数死亡发生在第一周内。单因素分析显示，低血压/休克、纵隔增宽、腹主动脉周围血肿、主动脉过度扩张(大于或等于6 cm)、昏迷/意识改变、肠系膜/肢体缺血、急性肾功能衰竭和手术治疗等住院并发症与死亡率升高有关(均P<；0.05)。控制年龄和性别的风险预测模型显示低血压/休克(优势比[OR]2 3.8，P=0.0001)、无胸背痛(OR 3.5，P=0.0 1)和分支血管受累(OR 2.9，P=0.0 2)，这些因素统称为“致命三联症”，是住院期间死亡的独立预测因素。在进行风险分层和决策时，应确定与住院死亡率增加(“致命的三合会”)相关的因素，并将其考虑在内。
Background - Clinical profiles and outcomes of patients with acute type B aortic dissection have not been evaluated in the current era.Methods and Results - Accordingly, we analyzed 384 patients ( 65 +/- 13 years, males 71%) with acute type B aortic dissection enrolled in the International Registry of Acute Aortic Dissection (IRAD). A majority of patients had hypertension and presented with acute chest/back pain. Only one-half showed abnormal findings on chest radiograph, and almost all patients had computerized tomography (CT), transesophageal echocardiography, magnetic resonance imaging (MRI), and/or aortogram to confirm the diagnosis. In-hospital mortality was 13% with most deaths occurring within the first week. Factors associated with increased in-hospital mortality on univariate analysis were hypotension/ shock, widened mediastinum, periaortic hematoma, excessively dilated aorta ( greater than or equal to 6 cm), in-hospital complications of coma/altered consciousness, mesenteric/limb ischemia, acute renal failure, and surgical management ( all P < 0.05). A risk prediction model with control for age and gender showed hypotension/ shock ( odds ratio [ OR] 23.8, P = 0.0001), absence of chest/back pain on presentation ( OR 3.5, P = 0.01), and branch vessel involvement ( OR 2.9, P = 0.02), collectively named `the deadly triad' to be independent predictors of in-hospital death.Conclusions - Our study provides insight into current-day profiles and outcomes of acute type B aortic dissection. Factors associated with increased in-hospital mortality ("the deadly triad") should be identified and taken into consideration for risk stratification and decision-making.