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Type-Selective Benefits of Medications in Treatment of Acute Aortic Dissection (from the International Registry of Acute Aortic Dissection [IRAD])

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The effects of medications on the outcome of aortic dissection remain poorly understood. We sought to address this by analyzing the International Registry of Acute Aortic Dissection (IRAD) global registry database. A total of 1,301 patients with acute aortic dissection (722 with type A and 579 with type B) with information on their medications at discharge and followed for ≤5 years were analyzed for the effects of the medications on mortality. The initial univariate analysis showed that use of β blockers was associated with improved survival in all patients (p = 0.03), in patients with type A overall (p = 0.02), and in patients with type A who received surgery (p = 0.006). The analysis also showed that use of calcium channel blockers was associated with improved survival in patients with type B overall (p = 0.02) and in patients with type B receiving medical management (p = 0.03). Multivariate models also showed that the use of β blockers was associated with improved survival in those with type A undergoing surgery (odds ratio 0.47, 95% confidence interval 0.25 to 0.90, p = 0.02) and the use of calcium channel blockers was associated with improved survival in patients with type B medically treated patients (odds ratio 0.55, 95% confidence interval 0.35 to 0.88, p = 0.01). In conclusion, the present study showed that use of β blockers was associated with improved outcome in all patients and in type A patients (overall as well as in those managed surgically). In contrast, use of calcium channel blockers was associated with improved survival selectively in those with type B (overall and in those treated medically). The use of angiotensin-converting enzyme inhibitors did not show association with mortality.

Section snippets

Methods

IRAD is a multinational registry of 24 referral centers in 12 countries. The details of the IRAD structure and methods used have been previously published.20, 21, 22, 23, 24

Data from all patients with aortic dissection enrolled in IRAD from December 26, 1995 with follow-up to 5 years was examined, with a focus on patients discharged alive with medication and follow-up data that included the use of medications. The collected data included variables on clinical, imaging, and mortality data.

Results

For the 1,301 patients with acute aortic dissection who survived to discharge and had information on the medications at discharge and during follow-up (median 26.0 months, interquartile range 12.0 to 48.0), the blood pressure status on admission showed that a little >1/2 (50.2%) of all patients were hypertensive. Most of the patients with type B (70.1%) were hypertensive. In contrast, more of the patients with type A were normotensive (43.9%) than hypertensive (33.7%), with a significantly

Discussion

Acute aortic dissection involves blood flow through an intimal tear into the aortic media of an often weakened aortic wall resulting from degeneration (e.g., atherosclerosis, aging, hypertension) and/or genetic predisposition (e.g., Marfan syndrome). The underlying principle of treatment is to limit propagation of the false lumen and its negative consequences on end-organ perfusion by reducing and stabilizing the hemodynamic stress on the aortic wall.1, 2, 3, 4, 5, 6, 7, 8 Surgical repair is

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