| Acute type B aortic dissection: does aortic arch involvement affect management and outcomes? Insights from the International Registry of Acute Aortic Dissection (IRAD). | |
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MedLine Citation:
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PMID: 17846296 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Stanford Type B acute aortic dissection (TB-AAD) spares the ascending aorta and is optimally managed with medical therapy in the absence of complications. However, the treatment of TB-AAD with aortic arch involvement (AAI) remains an unresolved issue. METHODS AND RESULTS: We examined 498 patients with TB-AAD enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and 2003. Kaplan-Meier mortality curves were constructed and multivariate regression models were performed to identify independent predictors of AAI and to evaluate whether AAI was an independent predictor of follow-up mortality. We found that 371 (74.5%) patients with TB-AAD did not have AAI versus 127 (25.5%) with AAI. Independent predictors of AAI were a history of previous aortic surgery (OR 3.4; 95% CI, 1.6 to 7.6; P=0.002), absence of back pain (OR 1.6; 95% CI, 1.1 to 2.5; P=0.05), and any pulse deficit (1.9; 95% CI, 1.1 to 3.3, P=0.03). Mortality for patients without AAI was 9.4%+/-4.3% and 21.0%+/-6.9% at 1 and 3 years versus 9.2%+/-7.7% and 19.9%+/-11.1% with AAI, respectively (mean follow-up overall, 2.3 years, log rank P=0.82). AAI was not an independent predictor of long-term mortality. CONCLUSIONS: Patients with TB-AAD and aortic arch involvement do not differ with regards to mortality at 3 years. Whether or not AAI involvement impacts other measures of morbidity such as freedom from operation or endovascular intervention deserves further study. |
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Authors:
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Thomas T Tsai; Eric M Isselbacher; Santi Trimarchi; Eduardo Bossone; Linda Pape; James L Januzzi; Arturo Evangelista; Jae K Oh; Alfredo Llovet; Joshua Beckman; Jeanna V Cooper; Dean E Smith; James B Froehlich; Rossella Fattori; Kim A Eagle; Christoph A Nienaber; |
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Publication Detail:
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Type: Comparative Study; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Circulation Volume: 116 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2007 Sep |
Date Detail:
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Created Date: 2007-09-11 Completed Date: 2007-10-11 Revised Date: 2007-12-03 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: I150-6 Citation Subset: AIM; IM |
Affiliation:
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University of Michigan Cardiovascular Center, 1500 E. Medical Center Dr, Ann Arbor, MI 48109-5853, USA. hsianshi@umich.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Aged Aneurysm, Dissecting / epidemiology*, therapy* Aorta, Thoracic / pathology* Aortic Aneurysm / epidemiology*, therapy* Cohort Studies Disease Management Female Follow-Up Studies Humans Internationality Male Middle Aged Registries* Treatment Outcome |
| Grant Support | |
ID/Acronym/Agency:
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5T32HL007853-08/HL/NHLBI NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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