Differential clinical features and long-term prognosis of acute aortic syndrome according to disease entity
Differential clinical features and long-term prognosis of acute aortic syndrome according to disease entity
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DOI：
10.1093/eurheartj/ehz153
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发表时间：
2019-08-21
影响因子：
39.3
通讯作者：
Song, Jae-Kwan
中科院分区：
文献类型：
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作者：
Ahn, Jung-Min;Kim, Hoyun;Song, Jae-Kwan
目的根据动脉壁内血肿(IMH)与主动脉夹层(AD)及解剖部位(A型与B型)评价急性主动脉综合征(AAS)的急性及远期预后。方法与结果1993-2015年间共收治AAS患者1012例，其中AD 672例，IMH 340例(33.6%)。与AD患者相比，IMH患者年龄更大，女性和远端主动脉受累的频率更高。总的住院粗死亡率为8.6%；A型AD[15.0%；调整危险比(AHR30.4；95%可信区间(CI)8.62-107.3；P<；0.001]；A型IMH(8.0%；AHR4.85；95%CI1.29-18.2；P=0.019)；B型AD(5.0%；AHR3.51；95%CI1.00-12.4；P=0.051)；B型IMH[1.5%；AHR 1.00(参考文献)]。在中位随访时间为8.5年(四分位数范围为4.013.5年)期间，AD(AHR2.78；95%CI1.87-4.14；P<；0.001)和A型(AHR2.28；95%CI1.45-3.58；P<；0.001)与主动脉死亡的风险相关。90天后，主动脉死亡的危险不再与解剖部位相关(AHR 0.74；95%CI 0.40~1.36；P=0.33)，而与疾病实体有关(AHR 1.83；95%CI 1.10~3.04；P=0.02)。结论IMH患者的临床特征、对治疗策略的反应和预后与AD患者不同。IMH的早期和晚期存活率均好于AD。除了AAS的解剖位置外，疾病实体也是AAS患者急性和长期死亡率的独立因素。进一步的研究是必要的，以确认疾病实体在不同患者群体中的预后意义。
Aims To evaluate the acute and long-term prognosis of acute aortic syndrome (AAS) according to the disease entity [intramural haematoma (IMH) vs. aortic dissection (AD)] and the anatomical location (type A vs. B).Methods and results A total of 1012 patients [672 with AD and 340 with IMH (33.6%)] were enrolled between 1993 and 2015. Compared with AD patients, IMH patients were older and had higher frequency of female sex and distal aorta involvement. The overall crude in-hospital mortality of AAS was 8.6%; type A AD [15.0%; adjusted hazard ratio (aHR) 30.4; 95% confidence interval (CI) 8.62-107.3; P < 0.001], type A IMH (8.0%; aHR 4.85; 95% CI 1.29-18.2; P = 0.019), type B AD (5.0%; aHR 3.51; 95% CI 1.00-12.4; P = 0.051), and type B IMH [1.5%; aHR 1.00 (reference)]. During a median follow-up duration of 8.5 years (interquartile range: 4.0-13.5 years), AD (aHR 2.78; 95% CI 1.87-4.14; P < 0.001) and type A (aHR 2.28; 95% CI 1.45-3.58; P < 0.001) was associated with a higher risk of aortic death. After 90 days, a risk of aortic death was no longer associated with anatomical location (aHR 0.74; 95% CI 0.40-1.36; P = 0.33), but remained associated with disease entity (aHR 1.83; 95% CI 1.10-3.04; P = 0.02).Conclusion The clinical features, response to treatment strategy, and outcomes of IMH patients were distinct from those of AD patients. Both early and late survival was better for IMH than for AD. In addition to the anatomical location of AAS, the disease entity is an independent factor associated with both acute and long-term mortality in patients with AAS. Further investigation is necessary to confirm the prognostic implication of disease entity in different patient populations.