Epidemiology and long-term prognostic factors in acute type B aortic dissection

The epidemiological data and reports on long-term predictors of mortality after medically or endovascularly and medically treated patients with acute type B aortic dissection ( AD) are scarce. Patients with type B AD between 2000 and 2004 were identified through the inpatient endovascular or autopsy registry at Malmo-Lund University Hospital, Sweden. Seventy-two patients had acute type B AD, of whom eight were found at autopsy. Shock due to ruptured type B AD was associated with in-hospital mortality ( P = 0.006) in the 64 eligible patients. Renal insufficiency ( odds ratio [ OR] 4.7, 95% confidence interval [ CI] 1.1-19.4) and coexistent aortic disease ( OR 4.1, 95% CI 1.0-16.9) remained as independent predictors for long-term mortality after multivariate logistic regression analysis. Endovascular intervention ( n = 32) was associated with neither short- nor long-term mortality. The estimated overall incidence of acute type B AD was 2.1/100,000 person-years, and the highest incidence rates were found in men aged 65-74 years ( 14.6/100,000 person-years) and women aged 75-84 years ( 19.0/100,000 person-years). Survival in patients with complicated acute type B AD managed with the endovascular technique was the same as in uncomplicated medically treated patients. Renal insufficiency and coexistent aortic disease were strong predictors for long-term mortality.