Minority Race Is Independently Associated With Need for Late Intervention in Medically Managed Type B Aortic Dissection

Despite favorable short-term outcomes for medically managed uncomplicated type B aortic dissection (TBAD), many patients require late intervention. Early identification of those at risk for disease progression may allow intervention before complications arise. However, conclusive data on risk factors for treatment failure are lacking. Our objective was to identify early clinical risk factors that predict need for late intervention in initially uncomplicated TBAD. This was a retrospective review of patients with acute uncomplicated TBAD who underwent primary medical management at a tertiary care center from 2009 to 2015. Demographics and admission data were collected. Primary end point was treatment failure, defined as late aortic intervention for TBAD complications. Admission characteristics among patients with or without treatment failure were compared by univariate and multivariate analyses. There were 241 patients who presented with acute TBAD. Those with index TBAD repair, history of type A dissection or prior thoracic aortic repair, concurrent type A dissection, or loss to follow-up were excluded. This yielded 78 medically managed TBAD patients (60% male; mean age, 59 years; 69% nonwhite) with a median follow-up of 3.5 years. Twenty-two (28%) required late intervention at a median of 2.2 years from index admission. Indications for repair included aneurysmal degeneration (17), persistent symptoms (3), renal malperfusion (1), and rupture (1). Patients requiring late intervention tended to be younger and had higher smoking rates (Table). Nonwhite race was more common in the late intervention group (91% vs 62%; P = .01). After multivariate logistic regression analysis, independent risk factors for treatment failure were nonwhite race (odds ratio, 6; 95% confidence interval, 2-44; P = .02) and smoking history (odds ratio, 5; 95% confidence interval, 1-20; P = .02). Mortality was similar between the patient groups (5%; P = 1.00). Among medically managed TBAD patients, minority race identifies patients at risk for treatment failure. Further study is required to define clinical and biologic factors that can help clarify racial differences in TBAD burden, management, and outcomes. Such patients may warrant more intensive medical therapy, more frequent surveillance, or aortic intervention to prevent disease progression.TableCharacteristics and outcomes of medically managed type B aortic dissection (TBAD) patientsNo.No late interventionLate interventionP5622Age, mean ± SD60 ± 14 years56 ± 13 years.18Age <50 years9 (16)8 (36).07Male30 (54)14 (64).46Nonwhite race34 (61)20 (91).01Hypertension53 (95)19 (86).34COPD8 (14)2 (9).72Chronic kidney disease9 (16)3 (13)1.00Smoking28 (50)16 (73).08Diabetes14 (25)4 (18).77Hyperlipidemia21 (38)5 (23).29Mortality3 (5)1 (5)1.00COPD, Chronic obstructive pulmonary disease; SD, standard deviation.Data are presented as number (%) unless otherwise indicated. Open table in a new tab