Partial thrombosis of the false lumen in patients with acute type B aortic dissection
Partial thrombosis of the false lumen in patients with acute type B aortic dissection
复制标题
DOI：
10.1056/nejmoa063232
复制
发表时间：
2007-07-26
影响因子：
158.5
通讯作者：
Eagle, Kim A.
中科院分区：
文献类型：
--
作者：
Tsai, Thomas T.;Evangelista, Arturo;Eagle, Kim A.
背景：B型急性主动脉夹层的假腔通畅或血栓形成被发现可以预测预后。假腔部分血栓形成的预后影响尚未阐明。方法：我们研究了201例B型急性主动脉夹层谁参加了1996年和2003年之间的急性主动脉夹层国际注册，谁存活出院。根据首次住院期间确定的假腔状态（通畅、部分血栓形成或完全血栓形成）对Kaplan-Meier死亡率曲线进行分层。考克斯比例风险分析，以确定独立的预测因素death.Results：在指数住院期间，114例（56.7%）有一个专利的假腔，68例（33.8%）有部分血栓形成的假腔，和19（9.5%）有完全血栓形成的假腔。假腔通畅患者的平均（+/-SD）3年死亡率为13.7 ± 7.1%，部分血栓形成患者为31.6 ± 12.4%，完全血栓形成患者为22.6 ± 22.6%（中位随访时间为2.8年;对数秩检验P=0.003）。假腔部分血栓形成是出院后死亡率的独立预测因素（相对风险，2.69; 95%置信区间[CI]，1.45至4.98; P=0.002），主动脉瘤病史（相对危险度，2.05; 95%CI，1.07 - 3.93; P=0.03），和动脉粥样硬化病史结论：急性B型主动脉夹层患者出院后死亡率高，其死亡率随病情的加重而升高，相对危险度为1.87，95%CI为1.01 ~ 3.47，P=0.05。与完全通畅相比，假腔部分血栓形成是这些患者出院后死亡率的重要独立预测因素。
Background: Patency or thrombosis of the false lumen in type B acute aortic dissection has been found to predict outcomes. The prognostic implications of partial thrombosis of the false lumen have not yet been elucidated.Methods: We examined 201 patients with type B acute aortic dissection who were enrolled in the International Registry of Acute Aortic Dissection between 1996 and 2003 and who survived to hospital discharge. Kaplan-Meier mortality curves were stratified according to the status of the false lumen (patent, partial thrombosis, or complete thrombosis) as determined during the index hospitalization. Cox proportional-hazards analysis was performed to identify independent predictors of death.Results: During the index hospitalization, 114 patients (56.7%) had a patent false lumen, 68 patients (33.8%) had partial thrombosis of the false lumen, and 19 (9.5%) had complete thrombosis of the false lumen. The mean (+/-SD) 3-year mortality rate for patients with a patent false lumen was 13.7+/-7.1%, for those with partial thrombosis was 31.6+/-12.4%, and for those with complete thrombosis was 22.6+/-22.6% (median follow-up, 2.8 years; P=0.003 by the log-rank test). Independent predictors of postdischarge mortality were partial thrombosis of the false lumen (relative risk, 2.69; 95% confidence interval [CI], 1.45 to 4.98; P=0.002), a history of aortic aneurysm (relative risk, 2.05; 95% CI, 1.07 to 3.93; P=0.03), and a history of atherosclerosis (relative risk, 1.87; 95% CI, 1.01 to 3.47; P=0.05).Conclusions: Mortality is high after discharge from the hospital among patients with type B acute aortic dissection. Partial thrombosis of the false lumen, as compared with complete patency, is a significant independent predictor of postdischarge mortality in these patients.