Age Related Outcomes in Patients with Type B Aortic Dissection: An Analysis of Over 16,000 patients
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0033
Submission Type:
Abstract Submission
Authors:
Mahnoor Imran (1), Danial Ahmad (2), Derek Serna-Gallegos (3), James Brown (2), Sarah Yousef (4), Floyd Thoma (2), Yisi Wang (2), David West (2), Danny Chu (5), Pyongsoo Yoon (2), Johannes Bonatti (6), David Kaczorowski (7), Francis Ferdinand (8), Ibrahim Sultan (3)
Institutions:
(1) N/A, United States, (2) UPMC, Pittsburgh, PA, (3) University of Pittsburgh Medical Center, Pittsburgh, PA, (4) University of Pittsburgh, Pittsburgh, PA, (5) Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, (6) UPMC Heart and Vascular Institute, Pittsburgh, PA, (7) University of Pittsburgh Medical Center, Venetia, PA, (8) UPMC, Erie, PA
Submitting Author:
Mahnoor Imran
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Co-Author(s):
Danial Ahmad
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UPMC
UPMC
Derek Serna-Gallegos
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University of Pittsburgh Medical Center
University of Pittsburgh Medical Center
James Brown
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UPMC
UPMC
Sarah Yousef
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University of Pittsburgh
University of Pittsburgh
Floyd Thoma
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UPMC
UPMC
Yisi Wang
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UPMC
UPMC
David West
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UPMC
UPMC
*Danny Chu
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Veterans Affairs Pittsburgh Healthcare System
Veterans Affairs Pittsburgh Healthcare System
Pyongsoo Yoon
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UPMC
UPMC
♦Johannes Bonatti
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UPMC Heart and Vascular Institute
UPMC Heart and Vascular Institute
*David Kaczorowski
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University of Pittsburgh Medical Center
University of Pittsburgh Medical Center
Francis Ferdinand
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UPMC
UPMC
*Ibrahim Sultan
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University of Pittsburgh Medical Center
University of Pittsburgh Medical Center
Presenting Author:
Mahnoor Imran
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Abstract:
Objective
Advanced age is a risk factor for poor prognosis after cardiac surgical procedures. This study sought to report age related morbidity and mortality outcomes of patients with Type B aortic dissections.
Methods
This was an observational study of patients with type B aortic dissections using the National Inpatient Sample (NIS) from 2016 to 2020. Patients were stratified into three age groups: <65 years, 66-75 years, and >75 years. Multivariable regression analysis was performed to identify variables associated with in-hospital mortality after a Type B aortic dissection.
Results
A total of 16,781 patients with Type B dissections were identified with 51.4% (8632) patients in the < 65 group, 23.2% (3888) in the 65-75 group, and 26% (4361) in the >75 group. Women comprised 39.8% (6677) of the patient population and were more likely to present at a later age (55.9% [2440] comprised >75 group, p<0.001). Patients above 75 years were more likely to have coronary artery disease (39.6% [1730], p<0.001), congestive heart failure (30.7% [1338], p<0.001), peripheral vascular disease (16.5% [720], p=0.009), and chronic kidney disease (27.6% [1204], p<0.001).
The in-hospital mortality for patients above 75 years of age was 16.7% [729] (p< 0.001). This group also had the lowest proportion of patients routinely discharged (23.69% [1033], p<0.001). Patients >75 years also had higher incidences of post-treatment heart failure (15.6% [679], p<0.001) and arrhythmia (31.3% [1364], p<0.001; however, rates of stroke (2% [171], p<0.0174) and spinal cord ischemia (2.1% [178], p<0.01) were highest in the <65 group. The median length of hospital stay was 6 days (3-11).
On multivariable mixed-model regression, age >75 was associated with odds of in-hospital mortality (OR: 2.729, [95%CI: 2.2-3.4], p<0.001). Other predictors included age 65-75 years (OR: 1.614 [1.347-1.933], p<0.001), non-elective procedure (OR: 3.090 [2.422-3.942], p<0.001), cerebrovascular disease (OR: 2.593 [2.203-3.052], p<0.001) and peripheral vascular disease (OR: 1.314 [1.175-1.470], p<0.001). Age as a continuous variable was also associated with mortality (OR:1.04 [1.01-1.03], p<0.001) (Figure).
Conclusions
Increase in age is associated with increased morbidity and mortality in patients with Type B aortic dissections likely due to baseline comorbidity burden. Preoperative conversations with patients and support members regarding outcomes may help adjudicate appropriate candidates for surgery.
Advanced age is a risk factor for poor prognosis after cardiac surgical procedures. This study sought to report age related morbidity and mortality outcomes of patients with Type B aortic dissections.
Methods
This was an observational study of patients with type B aortic dissections using the National Inpatient Sample (NIS) from 2016 to 2020. Patients were stratified into three age groups: <65 years, 66-75 years, and >75 years. Multivariable regression analysis was performed to identify variables associated with in-hospital mortality after a Type B aortic dissection.
Results
A total of 16,781 patients with Type B dissections were identified with 51.4% (8632) patients in the < 65 group, 23.2% (3888) in the 65-75 group, and 26% (4361) in the >75 group. Women comprised 39.8% (6677) of the patient population and were more likely to present at a later age (55.9% [2440] comprised >75 group, p<0.001). Patients above 75 years were more likely to have coronary artery disease (39.6% [1730], p<0.001), congestive heart failure (30.7% [1338], p<0.001), peripheral vascular disease (16.5% [720], p=0.009), and chronic kidney disease (27.6% [1204], p<0.001).
The in-hospital mortality for patients above 75 years of age was 16.7% [729] (p< 0.001). This group also had the lowest proportion of patients routinely discharged (23.69% [1033], p<0.001). Patients >75 years also had higher incidences of post-treatment heart failure (15.6% [679], p<0.001) and arrhythmia (31.3% [1364], p<0.001; however, rates of stroke (2% [171], p<0.0174) and spinal cord ischemia (2.1% [178], p<0.01) were highest in the <65 group. The median length of hospital stay was 6 days (3-11).
On multivariable mixed-model regression, age >75 was associated with odds of in-hospital mortality (OR: 2.729, [95%CI: 2.2-3.4], p<0.001). Other predictors included age 65-75 years (OR: 1.614 [1.347-1.933], p<0.001), non-elective procedure (OR: 3.090 [2.422-3.942], p<0.001), cerebrovascular disease (OR: 2.593 [2.203-3.052], p<0.001) and peripheral vascular disease (OR: 1.314 [1.175-1.470], p<0.001). Age as a continuous variable was also associated with mortality (OR:1.04 [1.01-1.03], p<0.001) (Figure).
Conclusions
Increase in age is associated with increased morbidity and mortality in patients with Type B aortic dissections likely due to baseline comorbidity burden. Preoperative conversations with patients and support members regarding outcomes may help adjudicate appropriate candidates for surgery.
Aortic Symposium:
Dissection
Image or Table
