Abstract
Background-: In patients with acute type B aortic dissection, presence of recurrent or refractory pain and/or refractory hypertension on medical therapy is sometimes used as an indication for invasive treatment. The International Registry of Acute Aortic Dissection (IRAD) was used to investigate the impact of refractory pain and/or refractory hypertension on the outcomes of acute type B aortic dissection. Methods And Results-: Three hundred sixty-five patients affected by uncomplicated acute type B aortic dissection, enrolled in IRAD from 1996 to 2004, were categorized according to risk profile into 2 groups. Patients with recurrent and/or refractory pain or refractory hypertension (group I; n=69) and patients without clinical complications at presentation (group II; n=296) were compared. "High-risk" patients with classic complications were excluded from this analysis. The overall in-hospital mortality was 6.5% and was increased in group I compared with group II (17.4% versus 4.0%; P=0.0003). The in-hospital mortality after medical management was significantly increased in group I compared with group II (35.6% versus 1.5%; P=0.0003). Mortality rates after surgical (20% versus 28%; P=0.74) or endovascular management (3.7% versus 9.1%; P=0.50) did not differ significantly between group I and group II, respectively. A multivariable logistic regression model confirmed that recurrent and/or refractory pain or refractory hypertension was a predictor of in-hospital mortality (odds ratio, 3.31; 95% confidence interval, 1.04 to 10.45; P=0.041). Conclusions-: Recurrent pain and refractory hypertension appeared as clinical signs associated with increased in-hospital mortality, particularly when managed medically. These observations suggest that aortic intervention, such as via an endovascular approach, may be indicated in this intermediate-risk group.
| Original language | English |
|---|---|
| Pages (from-to) | 1283-1289 |
| Number of pages | 7 |
| Journal | Circulation |
| Volume | 122 |
| Issue number | 13 |
| DOIs | |
| Publication status | Published - Sep 28 2010 |
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Keywords
- aorta
- surgery
- survival
ASJC Scopus subject areas
- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Cite this
Importance of refractory pain and hypertension in acute type B aortic dissection : Insights from the International Registry of Acute Aortic Dissection (IRAD). / Trimarchi, Santi; Eagle, Kim A.; Nienaber, Christoph A.; Pyeritz, Reed E.; Jonker, Frederik H W; Suzuki, Toru; O'Gara, Patrick T.; Hutchinson, Stuart J.; Rampoldi, Vincenzo; Grassi, Viviana; Bossone, Eduardo; Muhs, Bart E.; Evangelista, Arturo; Tsai, Thomas T.; Froehlich, Jim B.; Cooper, Jeanna V.; Montgomery, Dan; Meinhardt, Gabriel; Myrmel, Truls; Upchurch, Gilbert R.; Sundt, Thoralf M.; Isselbacher, Eric M.
In: Circulation, Vol. 122, No. 13, 28.09.2010, p. 1283-1289.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Importance of refractory pain and hypertension in acute type B aortic dissection
T2 - Insights from the International Registry of Acute Aortic Dissection (IRAD)
AU - Trimarchi, Santi
AU - Eagle, Kim A.
AU - Nienaber, Christoph A.
AU - Pyeritz, Reed E.
AU - Jonker, Frederik H W
AU - Suzuki, Toru
AU - O'Gara, Patrick T.
AU - Hutchinson, Stuart J.
AU - Rampoldi, Vincenzo
AU - Grassi, Viviana
AU - Bossone, Eduardo
AU - Muhs, Bart E.
AU - Evangelista, Arturo
AU - Tsai, Thomas T.
AU - Froehlich, Jim B.
AU - Cooper, Jeanna V.
AU - Montgomery, Dan
AU - Meinhardt, Gabriel
AU - Myrmel, Truls
AU - Upchurch, Gilbert R.
AU - Sundt, Thoralf M.
AU - Isselbacher, Eric M.
PY - 2010/9/28
Y1 - 2010/9/28
N2 - Background-: In patients with acute type B aortic dissection, presence of recurrent or refractory pain and/or refractory hypertension on medical therapy is sometimes used as an indication for invasive treatment. The International Registry of Acute Aortic Dissection (IRAD) was used to investigate the impact of refractory pain and/or refractory hypertension on the outcomes of acute type B aortic dissection. Methods And Results-: Three hundred sixty-five patients affected by uncomplicated acute type B aortic dissection, enrolled in IRAD from 1996 to 2004, were categorized according to risk profile into 2 groups. Patients with recurrent and/or refractory pain or refractory hypertension (group I; n=69) and patients without clinical complications at presentation (group II; n=296) were compared. "High-risk" patients with classic complications were excluded from this analysis. The overall in-hospital mortality was 6.5% and was increased in group I compared with group II (17.4% versus 4.0%; P=0.0003). The in-hospital mortality after medical management was significantly increased in group I compared with group II (35.6% versus 1.5%; P=0.0003). Mortality rates after surgical (20% versus 28%; P=0.74) or endovascular management (3.7% versus 9.1%; P=0.50) did not differ significantly between group I and group II, respectively. A multivariable logistic regression model confirmed that recurrent and/or refractory pain or refractory hypertension was a predictor of in-hospital mortality (odds ratio, 3.31; 95% confidence interval, 1.04 to 10.45; P=0.041). Conclusions-: Recurrent pain and refractory hypertension appeared as clinical signs associated with increased in-hospital mortality, particularly when managed medically. These observations suggest that aortic intervention, such as via an endovascular approach, may be indicated in this intermediate-risk group.
AB - Background-: In patients with acute type B aortic dissection, presence of recurrent or refractory pain and/or refractory hypertension on medical therapy is sometimes used as an indication for invasive treatment. The International Registry of Acute Aortic Dissection (IRAD) was used to investigate the impact of refractory pain and/or refractory hypertension on the outcomes of acute type B aortic dissection. Methods And Results-: Three hundred sixty-five patients affected by uncomplicated acute type B aortic dissection, enrolled in IRAD from 1996 to 2004, were categorized according to risk profile into 2 groups. Patients with recurrent and/or refractory pain or refractory hypertension (group I; n=69) and patients without clinical complications at presentation (group II; n=296) were compared. "High-risk" patients with classic complications were excluded from this analysis. The overall in-hospital mortality was 6.5% and was increased in group I compared with group II (17.4% versus 4.0%; P=0.0003). The in-hospital mortality after medical management was significantly increased in group I compared with group II (35.6% versus 1.5%; P=0.0003). Mortality rates after surgical (20% versus 28%; P=0.74) or endovascular management (3.7% versus 9.1%; P=0.50) did not differ significantly between group I and group II, respectively. A multivariable logistic regression model confirmed that recurrent and/or refractory pain or refractory hypertension was a predictor of in-hospital mortality (odds ratio, 3.31; 95% confidence interval, 1.04 to 10.45; P=0.041). Conclusions-: Recurrent pain and refractory hypertension appeared as clinical signs associated with increased in-hospital mortality, particularly when managed medically. These observations suggest that aortic intervention, such as via an endovascular approach, may be indicated in this intermediate-risk group.
KW - aorta
KW - surgery
KW - survival
UR - http://www.scopus.com/inward/record.url?scp=77957962302&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77957962302&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.109.929422
DO - 10.1161/CIRCULATIONAHA.109.929422
M3 - Article
C2 - 20837896
AN - SCOPUS:77957962302
VL - 122
SP - 1283
EP - 1289
JO - Circulation
JF - Circulation
SN - 0009-7322
IS - 13
ER -