Acute type B aortic dissection in elderly patients: clinical features, outcomes, and simple risk stratification rule Rajendra H Mehta, MD, MS, Eduardo.

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Presentation transcript:

Acute type B aortic dissection in elderly patients: clinical features, outcomes, and simple risk stratification rule Rajendra H Mehta, MD, MS, Eduardo Bossone, MD, Arturo Evangelista, MD, Patrick T O'Gara, MD, Dean E Smith, PhD, Jeanna V Cooper, MS, Jae K Oh, MD, James L Januzzi, MD, Stuart Hutchison, MD, Dan Gilon, MD, Linda A Pape, MD, Christoph A Nienaber, MD, Eric M Isselbacher, MD, Kim A Eagle, MD The Annals of Thoracic Surgery Volume 77, Issue 5, Pages 1622-1628 (May 2004) DOI: 10.1016/j.athoracsur.2003.10.072

Fig 1 Survival curves for death due to type B dissection by age group and management strategies. Kaplan-Meier survival curves for patients with acute type B aortic dissection aged 70 years or more versus those less than 70 years of age stratified by treatment types. Log rank test p = 0.10 for older versus younger patients managed medically, and p = 0.13 for the two age groups managed with surgery. The Annals of Thoracic Surgery 2004 77, 1622-1628DOI: (10.1016/j.athoracsur.2003.10.072)

Fig 2 Classification tree for the risk of in-hospital death in elderly patients (≥70 years) with acute type B aortic dissection. Please note that patients with hypotension or shock have the highest risk of death (56.0%). In absence of this, any branch vessel involvement is associated with the next highest mortality rate (28.6%), followed by presence of periaortic hematoma (10.5%). Elderly patients without any evidence of these three factors have the lowest mortality rate (1.3%). The Annals of Thoracic Surgery 2004 77, 1622-1628DOI: (10.1016/j.athoracsur.2003.10.072)

Fig 3 In-hospital mortality in low- and high-risk groups: mortality rate for patients aged less than 70 years versus those aged 70 years or more with acute type B aortic dissection stratified into low- and high-risk categories. High-risk patients are those with hypotension or shock, any branch vessel involvement, or periaortic hematoma. Low-risk patients are those without these three risk factors. The Annals of Thoracic Surgery 2004 77, 1622-1628DOI: (10.1016/j.athoracsur.2003.10.072)