Prognostic Factors in Patient with Aortic Dissection

Lee, Seok; Yun, Nam Sig; Chung, Jong Won; Cho, Jung Sun; Hwang, Seung Hwan; Kim, Weon; Park, Jong Chun; Cho, Jeong Gwan; Jeong, Myung Ho

Abstract

The prognosis of aortic dissection had remained of controversy, so we investigate the prognosis and associated risk factors in patient with aortic dissection. The seventy patients including 31 men, 39 women admitted via Chonnam National University Hospital emergency room under diagnosis of aortic dissection after August 2003 were involved. Blood pressure, past history, lipid abnormality, acute phase reactants (ESR, CRP, etc), white blood cell count, monocyte at admission were investigated. Echocardiography and CT for diagnosis of cardiac and aortic diseases were also reviewed. Death and progression was reviewed the medical records and others by telephone. The treatment modalities (medical treatment or stent insertion or surgical treatment) and results of each patient were compared. Old women (39 persons, 56%), hypertension (53 persons, 75.7%), inflammatory markers (average monocyte: 745.8/mm3, ESR: 37.0 mm/hr, CRP: 7.9 mg/dl, D-dimer: 1.6 mg/L) and hyperlipidemia (average LDL cholesterol: 113.5 mg/dl) appeared to be significant risk factors of aortic dissections. Over 60 years old age (p<0.05, OR=2.85), Stanford type A (p<0.05, OR=2.24) and typical aortic dissection (p<0.05, OR=1.15) have worse prognosis with increased incidences of disease progression including death. Nineteen patients (27.1%) that have surgical procedure show lowering progression of disease (p <0.05, OR=2.80) including death. These data suggest that aggressive treatments including surgical intervention may be associated with better prognosis in high risk groups of patients with aortic dissections, who is over 60 years, typical aortic dissection, Stanford type A aortic dissection.