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Previous Volume 357:349-359 July 26, 2007 Number 4 Next

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ABSTRACT

Background Patency or thrombosis of the false lumen in type B acute aortic dissection has been found to predict outcomes. The prognostic implications of partial thrombosis of the false lumen have not yet been elucidated.

Methods We examined 201 patients with type B acute aortic dissection who were enrolled in the International Registry of Acute Aortic Dissection between 1996 and 2003 and who survived to hospital discharge. Kaplan–Meier mortality curves were stratified according to the status of the false lumen (patent, partial thrombosis, or complete thrombosis) as determined during the index hospitalization. Cox proportional-hazards analysis was performed to identify independent predictors of death.

Results During the index hospitalization, 114 patients (56.7%) had a patent false lumen, 68 patients (33.8%) had partial thrombosis of the false lumen, and 19 (9.5%) had complete thrombosis of the false lumen. The mean (±SD) 3-year mortality rate for patients with a patent false lumen was 13.7±7.1%, for those with partial thrombosis was 31.6±12.4%, and for those with complete thrombosis was 22.6±22.6% (median follow-up, 2.8 years; P=0.003 by the log-rank test). Independent predictors of postdischarge mortality were partial thrombosis of the false lumen (relative risk, 2.69; 95% confidence interval [CI], 1.45 to 4.98; P=0.002), a history of aortic aneurysm (relative risk, 2.05; 95% CI, 1.07 to 3.93; P=0.03), and a history of atherosclerosis (relative risk, 1.87; 95% CI, 1.01 to 3.47; P=0.05).

Conclusions Mortality is high after discharge from the hospital among patients with type B acute aortic dissection. Partial thrombosis of the false lumen, as compared with complete patency, is a significant independent predictor of postdischarge mortality in these patients.

Source Information

From the Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor (T.T.T., J.V.C., D.E.S., J.F., K.A.E.); the Hospital General Universitari Vall d'Hebron, Barcelona (A.E.); the University of Rostock, Rostock, Germany (C.A.N.); Tromsø University Hospital, Tromsø, Norway (T.M.); Robert-Bosch Krankenhaus, Stuttgart, Germany (G.M.); the University of Tokyo, Tokyo (T. Suzuki); University Hospital S. Orsola, Bologna, Italy (R.F.); Hospital Universitario 12 de Octubre, Madrid (A.L.); St. Michael's Hospital, Toronto (S.H.); the National Research Council, Lecce, Italy (A.D.); the Mayo Clinic, Rochester, MN (T. Sundt); Brigham and Women's Hospital, Boston (J.B.); and Massachusetts General Hospital, Boston (J.L.J., E.M.I.).

Address reprint requests to Dr. Tsai at the University of Michigan Cardiovascular Center, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-5853, or at hsianshi{at}umich.edu.

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Related Letters:

Partial Thrombosis of the False Lumen in Aortic Dissection
Takagi H., Kawai N., Umemoto T., Wong B., Tsai T. T., Eagle K. A.
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N Engl J Med 2007; 357:1868-1869, Nov 1, 2007. Correspondence

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