The IRAD Classification System for Characterizing Survival after Aortic Dissection
The IRAD Classification System for Characterizing Survival after Aortic Dissection
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DOI：
10.1016/j.amjmed.2013.01.020
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发表时间：
2013-08-01
影响因子：
5.9
通讯作者：
Eagle, Kim A.
中科院分区：
文献类型：
--
作者：
Booher, Anna M.;Isselbacher, Eric M.;Eagle, Kim A.
背景技术背景：急性（≥ 14天）主动脉夹层的分类是基于现代诊断和治疗方式可用之前数十年接受治疗的患者的生存率估计。一个新的分类主动脉夹层在当前的时代，可以提供临床医生一个更精确的方法来表征的相互作用的时间，夹层的位置，和治疗类型与survival.METHODS：我们开发了单独的Kaplan-Meier生存曲线A型和B型主动脉夹层使用的数据从国际注册表主动脉夹层（IRAD）。根据提供的治疗类型对日生存率进行分层：单独药物治疗（药物）、非手术干预加药物治疗（血管内）和开放手术加药物治疗（手术）。采用log-rank统计法比较A型和B型主动脉夹层中每种治疗方式的生存曲线。结果：共纳入1815例患者，男性占67.3%，平均年龄62.0 ± 14.2岁。当构建存活曲线时，注意到4个不同的时间段：超急性（症状发作至24小时）、急性（2-7天）、亚急性（8-30天）和慢性（>30天）。通过4个时间periods.CONCLUSIONS：这个IRAD分类系统可以为临床医生提供一个更强大的方法来表征主动脉夹层后生存随着时间的推移比以前的方法。该系统将有助于治疗患者，咨询患者和家属，并研究新的诊断和治疗方法。(C)2013 Elsevier Inc. All rights reserved.
BACKGROUND: The classification of aortic dissection into acute (= 14 days) is based on survival estimates of patients treated decades before modern diagnostic and treatment modalities were available. A new classification of aortic dissection in the current era may provide clinicians with a more precise method of characterizing the interaction of time, dissection location, and treatment type with survival.METHODS: We developed separate Kaplan-Meier survival curves for Type A and Type B aortic dissection using data from the International Registry of Aortic Dissection (IRAD). Daily survival was stratified based on type of therapy provided: medical therapy alone (medical), nonsurgical intervention plus medical therapy (endovascular), and open surgery plus medical therapy (surgical). The log-rank statistic was used to compare the survival curves of each management type within Type A and Type B aortic dissection.RESULTS: There were 1815 patients included, 67.3% male with mean age 62.0 +/- 14.2 years. When survival curves were constructed, 4 distinct time periods were noted: hyperacute (symptom onset to 24 hours), acute (2-7 days), subacute (8-30 days), and chronic (>30 days). Overall survival was progressively lower through the 4 time periods.CONCLUSIONS: This IRAD classification system can provide clinicians with a more robust method of characterizing survival after aortic dissection over time than previous methods. This system will be useful for treating patients, counseling patients and families, and studying new diagnostic and treatment methods. (C) 2013 Elsevier Inc. All rights reserved.