Determinants of Long-Term Mortality in Patients With Type B Acute Aortic Dissection

BACKGROUND Type B acute aortic dissection (AAD) carries a high short- and midterm mortality rate; however, knowledge related to long-term outcome is largely incomplete. The objective of this study was to identify long-term predictors including anti hypertensive medications in type B AAD. METHODS We conducted a clinical follow-up study on 202 type B AAD patients. Univariate and multivariate Cox regression analyses were performed to identify predictors of mortality. RESULTS There were 44 postdischarge deaths in 202 consecutive type B AAD patients with a median follow-up of 55 months. In univariate Cox-regression analysis, age (10 year incremental: hazard ratio (HR) 1.82, 95% confidence interval (CI) 1.35-2.46, P < 0.0001), previous myocardial infarction or angina pectoris (HR 3.93, 95% Cl 1.72-8.99, P = 0.001), and impaired renal function (HR 4.90, 95% Cl 2.48-9.65, P < 0.0001) were predictors of death. Calcium channel blockers (CCBs), beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors as anti hypertensive medications at discharge were predictors of increased survival. In multivariate Cox regression analysis, CCBs were a significant predictor of increased survival (vs. no anti hypertensive medication at discharge: HR 0.38, 95% Cl 0.15-0.97, P = 0.04). Impaired renal function was a significant predictor of death (HR 3.41, 95% Cl 1.58-7.33, P = 0.002). No anti hypertensive medication at discharge group was significantly associated with increased mortality (vs. 1 class of antihypertensive medication: HR9.51, 95% Cl 1.85-48.79, P = 0.007). CONCLUSIONS Impaired renal function was a predictor for adverse outcome in patients with type B AAD. The use of CCBs as anti hypertensive medication at discharge was associated with increased survival.