• Thomas T Tsai, Arturo Evangelista, Christoph A Nienaber, Truls Myrmel, Gabriel Meinhardt, Jeanna V Cooper, Dean E Smith, Toru Suzuki, Rossella Fattori, Alfredo Llovet, James Froehlich, Stuart Hutchison, Alessandro Distante, Thoralf Sundt, Joshua Beckman, James L Januzzi, Eric M Isselbacher, Kim A Eagle, and International Registry of Acute Aortic Dissection.
• Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, MI 48109-5853, USA. hsianshi@umich.edu
• N. Engl. J. Med. 2007 Jul 26; 357 (4): 349-59.

BackgroundPatency or thrombosis of the false lumen in type B acute aortic dissection has been found to predict outcomes. The prognostic implications of partial thrombosis of the false lumen have not yet been elucidated.MethodsWe examined 201 patients with type B acute aortic dissection who were enrolled in the International Registry of Acute Aortic Dissection between 1996 and 2003 and who survived to hospital discharge. Kaplan-Meier mortality curves were stratified according to the status of the false lumen (patent, partial thrombosis, or complete thrombosis) as determined during the index hospitalization. Cox proportional-hazards analysis was performed to identify independent predictors of death.ResultsDuring the index hospitalization, 114 patients (56.7%) had a patent false lumen, 68 patients (33.8%) had partial thrombosis of the false lumen, and 19 (9.5%) had complete thrombosis of the false lumen. The mean (+/-SD) 3-year mortality rate for patients with a patent false lumen was 13.7+/-7.1%, for those with partial thrombosis was 31.6+/-12.4%, and for those with complete thrombosis was 22.6+/-22.6% (median follow-up, 2.8 years; P=0.003 by the log-rank test). Independent predictors of postdischarge mortality were partial thrombosis of the false lumen (relative risk, 2.69; 95% confidence interval [CI], 1.45 to 4.98; P=0.002), a history of aortic aneurysm (relative risk, 2.05; 95% CI, 1.07 to 3.93; P=0.03), and a history of atherosclerosis (relative risk, 1.87; 95% CI, 1.01 to 3.47; P=0.05).ConclusionsMortality is high after discharge from the hospital among patients with type B acute aortic dissection. Partial thrombosis of the false lumen, as compared with complete patency, is a significant independent predictor of postdischarge mortality in these patients.Copyright 2007 Massachusetts Medical Society.

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