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- Title
Determinants of Long-Term Mortality in Patients With Type B Acute Aortic Dissection.
- Authors
Sakakura, Kenichi; Kubo, Norifumi; Ako, Junya; Fujiwara, Naoki; Funayama, Hiroshi; Ikeda, Nahoko; Nakamura, Tomohiro; Sugawara, Yoshitaka; Yasu, Takanori; Kawakami, Masanobu; Momomura, Shin-ichi
- Abstract
BackgroundType 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 antihypertensive medications in type B AAD.MethodsWe 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.ResultsThere 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% CI 1.72–8.99, P = 0.001), and impaired renal function (HR 4.90, 95% CI 2.48–9.65, P < 0.0001) were predictors of death. Calcium channel blockers (CCBs), β-blockers, and angiotensin-converting enzyme (ACE) inhibitors as antihypertensive medications at discharge were predictors of increased survival. In multivariate Cox regression analysis, CCBs were a significant predictor of increased survival (vs. no antihypertensive medication at discharge: HR 0.38, 95% CI 0.15–0.97, P = 0.04). Impaired renal function was a significant predictor of death (HR 3.41, 95% CI 1.58–7.33, P = 0.002). No antihypertensive medication at discharge group was significantly associated with increased mortality (vs. 1 class of antihypertensive medication: HR9.51, 95% CI 1.85–48.79, P = 0.007).ConclusionsImpaired renal function was a predictor for adverse outcome in patients with type B AAD. The use of CCBs as antihypertensive medication at discharge was associated with increased survival.American Journal of Hypertension 2009; doi:10.1038/ajh.2009.5American Journal of Hypertension (2009); 22, 4, 371–377. doi:10.1038/ajh.2009.5
- Subjects
MORTALITY; AORTIC dissection; PATIENTS; ANTIHYPERTENSIVE agents; MYOCARDIAL infarction; ANGINA pectoris; CALCIUM antagonists; MULTIVARIATE analysis
- Publication
American Journal of Hypertension, 2009, Vol 22, Issue 4, p371
- ISSN
0895-7061
- Publication type
Article
- DOI
10.1038/ajh.2009.5