Importance of refractory pain and hypertension in acute type B aortic dissection: Insights from the International Registry of Acute Aortic Dissection (IRAD)

Santi Trimarchi, Kim A. Eagle, Christoph A. Nienaber, Reed E. Pyeritz, Frederik H W Jonker, Toru Suzuki, Patrick T. O'Gara, Stuart J. Hutchinson, Vincenzo Rampoldi, Viviana Grassi, Eduardo Bossone, Bart E. Muhs, Arturo Evangelista, Thomas T. Tsai, Jim B. Froehlich, Jeanna V. Cooper, Dan Montgomery, Gabriel Meinhardt, Truls Myrmel, Gilbert R. UpchurchThoralf M. Sundt, Eric M. Isselbacher

Research output: Contribution to journalArticle

107 Citations (Scopus)

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 languageEnglish
Pages (from-to)1283-1289
Number of pages7
JournalCirculation
Volume122
Issue number13
DOIs
Publication statusPublished - Sep 28 2010

Fingerprint

Intractable Pain
Registries
Dissection
Hospital Mortality
Hypertension
Logistic Models
Odds Ratio
Confidence Intervals
Mortality
Therapeutics

Keywords

  • aorta
  • surgery
  • survival

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Trimarchi, S., Eagle, K. A., Nienaber, C. A., Pyeritz, R. E., Jonker, F. H. W., Suzuki, T., ... Isselbacher, E. M. (2010). Importance of refractory pain and hypertension in acute type B aortic dissection: Insights from the International Registry of Acute Aortic Dissection (IRAD). Circulation, 122(13), 1283-1289. https://doi.org/10.1161/CIRCULATIONAHA.109.929422

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 journalArticle

Trimarchi, S, Eagle, KA, Nienaber, CA, Pyeritz, RE, Jonker, FHW, Suzuki, T, O'Gara, PT, Hutchinson, SJ, Rampoldi, V, Grassi, V, Bossone, E, Muhs, BE, Evangelista, A, Tsai, TT, Froehlich, JB, Cooper, JV, Montgomery, D, Meinhardt, G, Myrmel, T, Upchurch, GR, Sundt, TM & Isselbacher, EM 2010, 'Importance of refractory pain and hypertension in acute type B aortic dissection: Insights from the International Registry of Acute Aortic Dissection (IRAD)', Circulation, vol. 122, no. 13, pp. 1283-1289. https://doi.org/10.1161/CIRCULATIONAHA.109.929422
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. / Importance of refractory pain and hypertension in acute type B aortic dissection : Insights from the International Registry of Acute Aortic Dissection (IRAD). In: Circulation. 2010 ; Vol. 122, No. 13. pp. 1283-1289.
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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.

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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.

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