Factors affecting acute aortic dissection mortality: A multicentre cohort study

TL;DR

This study finds that type A aortic dissection, older age, and non-surgical treatment are linked to higher mortality rates in patients with acute aortic dissection.

Contribution

The study identifies specific clinical and temporal factors associated with mortality in acute aortic dissection patients.

Findings

Type A dissection patients had 3 times higher in-hospital mortality than type B patients.

Each additional year of age increased in-hospital mortality odds by 4% for type A patients.

Conservative management increased in-hospital mortality odds 10.9 times compared to surgery for type A patients.

Abstract

Acute aortic dissection (AAD) is an emergency associated with high mortality. Timely diagnosis is challenging, and delays may affect patient outcomes. We aimed to identify clinical and temporal factors associated with mortality after AAD.

We performed a retrospective cohort study across four tertiary hospitals of type A and type B AADs diagnosed over a 20-year period. The outcomes of the study were in-hospital mortality, 30-day mortality, and mid-term (6-month) mortality. Univariate linear and bivariate logistic regression analyses were conducted to evaluate the relationship between mortality and demographic and clinical factors.

The study included 149 AAD patients. Of these, 103 (69.1 %) were Stanford type A and 46 (30.9 %) Stanford type B. In-hospital mortality was 29.1 % (n = 30) for type A vs 10.9 % (n = 5) for type B. For type A patients, every one-year increase in age increased odds of in-hospital mortality by 4 % (p = 0.0076), and odds of in-hospital mortality were 10.9 times greater with conservative management than surgical (p < 0.0001). Patients with type A dissection had odds of in-hospital mortality 3.0 times greater than type B (p = 0.0005). 30-day mortality rate was 29.1 % (n = 30) for type A dissection vs 10.9 % (n = 5) for type B. 6-month mortality rate was 30.1 % (n = 31) for type A dissection vs 10.9 % (n = 5) for type B. Predictors of 30-day and 6-month mortality were similar to those of in-hospital mortality.

Even with tertiary care AAD carries a high burden of mortality. Those with type A dissections, increased age, and non-surgical management are at an increased risk of mortality.