Document Detail

Importance of refractory pain and hypertension in acute type B aortic dissection: insights from the International Registry of Acute Aortic Dissection (IRAD).
MedLine Citation:
PMID:  20837896     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In patients with acute type B aortic dissection, presence of recurrent or refractory pain and/or refractory hypertension on medical therapy is sometimes used as an indication for invasive treatment. The International Registry of Acute Aortic Dissection (IRAD) was used to investigate the impact of refractory pain and/or refractory hypertension on the outcomes of acute type B aortic dissection.
METHODS AND RESULTS: Three hundred sixty-five patients affected by uncomplicated acute type B aortic dissection, enrolled in IRAD from 1996 to 2004, were categorized according to risk profile into 2 groups. Patients with recurrent and/or refractory pain or refractory hypertension (group I; n=69) and patients without clinical complications at presentation (group II; n=296) were compared. "High-risk" patients with classic complications were excluded from this analysis. The overall in-hospital mortality was 6.5% and was increased in group I compared with group II (17.4% versus 4.0%; P=0.0003). The in-hospital mortality after medical management was significantly increased in group I compared with group II (35.6% versus 1.5%; P=0.0003). Mortality rates after surgical (20% versus 28%; P=0.74) or endovascular management (3.7% versus 9.1%; P=0.50) did not differ significantly between group I and group II, respectively. A multivariable logistic regression model confirmed that recurrent and/or refractory pain or refractory hypertension was a predictor of in-hospital mortality (odds ratio, 3.31; 95% confidence interval, 1.04 to 10.45; P=0.041).
CONCLUSIONS: Recurrent pain and refractory hypertension appeared as clinical signs associated with increased in-hospital mortality, particularly when managed medically. These observations suggest that aortic intervention, such as via an endovascular approach, may be indicated in this intermediate-risk group.
Santi Trimarchi; Kim A Eagle; Christoph A Nienaber; Reed E Pyeritz; Frederik H W Jonker; Toru Suzuki; Patrick T O'Gara; Stuart J Hutchinson; Vincenzo Rampoldi; Viviana Grassi; Eduardo Bossone; Bart E Muhs; Arturo Evangelista; Thomas T Tsai; Jim B Froehlich; Jeanna V Cooper; Dan Montgomery; Gabriel Meinhardt; Truls Myrmel; Gilbert R Upchurch; Thoralf M Sundt; Eric M Isselbacher;
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-09-13
Journal Detail:
Title:  Circulation     Volume:  122     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-29     Completed Date:  2010-10-18     Revised Date:  2011-08-10    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1283-9     Citation Subset:  AIM; IM    
Policlinico San Donato IRCCS, Cardiovascular Center E. Malan, University of Milano, via Morandi 30, 20097 San Donato Milanese, Italy.
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MeSH Terms
Acute Disease
Aneurysm, Dissecting / complications*,  mortality,  surgery
Aortic Aneurysm / complications*,  mortality,  surgery
Hospital Mortality
Hypertension / complications*
Logistic Models
Middle Aged
Pain / complications*
Vascular Surgical Procedures
Comment In:
Circulation. 2011 Jun 21;123(24):e636   [PMID:  21690497 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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