P261. Predictors of Aortic Rupture in Thoracic Aortic Aneurysms
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
UPMC
Pittsburgh, PA
United States - Contact Me
Danial Ahmad is a Postdoctoral Associate in the division of cardiac surgery, department of cardiothoracic surgery at University of Pittsburgh. His current research interests are aortic diseases with a special focus on the thoracic aorta as well as structural heart disease.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective: Rupture of thoracic aortic aneurysms (TAA) is a rare and life-threatening complication with high mortality rates. We sought to identify demographic and clinical predictors of aortic rupture in patients with TAA.
Methods: A retrospective review of medical records for all patients presenting to our institution with the diagnosis of TAA from 2010-2020 was conducted. Patients were stratified into two cohorts: rupture vs no rupture. Baseline characteristics, labs at admission, and post-treatment outcomes were compared between the groups. Univariate and multivariate stepwise logistic regression analysis were undertaken to identify statistically significant predictors of rupture. Imputation by median was performed If <15% data for any variable were missing. Survival was compared between the groups using Kaplan-Meier analysis.
Results: A total of 3902 TAA patients were included of which 3.7% (144/3902) had ruptured aneurysms. Median age was 71 years (61-80) and more women had ruptured TAA (55.6% (80/144) vs. 38.7% (1455/3758), p<0.001). End-stage renal disease (3.45% (3/87) vs. 0.76% (24/3144), p=0.007) was more prevalent in the rupture cohort.
Higher levels of C-reactive protein (CRP) (15.7mg/L (7.6-22.2) vs. 5mg/L (1.0 vs. 11.8), p=0.003), neutrophil-lymphocyte ratio (6.3 (3.1-12.6) vs. 4.5 (2.7 vs. 8.2), p=0.016), serum creatinine (1.06mg/dL (0.9-1.3) vs. 1.0mg/dL (0.8-1.16), p<0.001), and maximum TAA size (5.6cm (4.7-7.0) vs. 4.7cm (4.3-5.4), p<0.001) were observed in patients with ruptured aneurysms.
30-day mortality (51.4% (74/144 ) vs. 4.2% (158/3758), p<0.001) was higher in the rupture cohort. Overall mortality was 31.6% (1233/3902) at a followup of 3.6 years (1.4-6.8). Kaplan-Meier survival analysis further showed significantly worse survival in the rupture cohort (Logrank p=<0.001) (Figure).
The multivariable logistic regression model (C-statistic: 0.80) showed that white race (Odds Ratio (OR): 0.432 (95%CI: 0.216-0.866), p=0.018) was protective for risk of rupture while female sex (OR: 2.269 (1.036-4.971), p=0.041), increased neutrophil-lymphocyte ratio (OR: 1.023 (1.001-1.046), p=0.039) and maximum aneurysm size (OR: 1.703 (1.436-2.020), p<0.001) significantly increased the odds of rupture.
Conclusions: Non-white women with high neutrophil-lymphocyte ratios, CRP, and maximum aneurysm sizes were more predisposed to TAA rupture. Given the poor outcomes associated with aortic rupture, further validation of inflammatory markers and patient demographics as predictors of rupture is needed to define high-risk populations and initiate timely interventions.
Authors
Danial Ahmad (1), Derek Serna-Gallegos (2), Nidhi Iyanna (3), Jack Donohue (4), Yisi Wang (1), Floyd Thoma (1), Sarah Yousef (5), James Brown (1), Julie Phillippi (6), Michel Pompeu Sá (7), Johannes Bonatti (8), David Kaczorowski (9), Pyongsoo Yoon (1), Danny Chu (10), Ibrahim Sultan (2)
Institutions
(1) UPMC, Pittsburgh, PA, (2) University of Pittsburgh Medical Center, Pittsburgh, PA, (3) University of Pittsburgh Medical Center, N/A, (4) N/A, N/A, (5) University of Pittsburgh, Pittsburgh, PA, (6) N/A, Pittsburgh, PA, (7) PROCAPE / University of Pernambuco, Recife, Pernambuco, (8) UPMC Heart and Vascular Institute, Pittsburgh, PA, (9) University of Pittsburgh Medical Center, Venetia, PA, (10) Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
Methods: A retrospective review of medical records for all patients presenting to our institution with the diagnosis of TAA from 2010-2020 was conducted. Patients were stratified into two cohorts: rupture vs no rupture. Baseline characteristics, labs at admission, and post-treatment outcomes were compared between the groups. Univariate and multivariate stepwise logistic regression analysis were undertaken to identify statistically significant predictors of rupture. Imputation by median was performed If <15% data for any variable were missing. Survival was compared between the groups using Kaplan-Meier analysis.
Results: A total of 3902 TAA patients were included of which 3.7% (144/3902) had ruptured aneurysms. Median age was 71 years (61-80) and more women had ruptured TAA (55.6% (80/144) vs. 38.7% (1455/3758), p<0.001). End-stage renal disease (3.45% (3/87) vs. 0.76% (24/3144), p=0.007) was more prevalent in the rupture cohort.
Higher levels of C-reactive protein (CRP) (15.7mg/L (7.6-22.2) vs. 5mg/L (1.0 vs. 11.8), p=0.003), neutrophil-lymphocyte ratio (6.3 (3.1-12.6) vs. 4.5 (2.7 vs. 8.2), p=0.016), serum creatinine (1.06mg/dL (0.9-1.3) vs. 1.0mg/dL (0.8-1.16), p<0.001), and maximum TAA size (5.6cm (4.7-7.0) vs. 4.7cm (4.3-5.4), p<0.001) were observed in patients with ruptured aneurysms.
30-day mortality (51.4% (74/144 ) vs. 4.2% (158/3758), p<0.001) was higher in the rupture cohort. Overall mortality was 31.6% (1233/3902) at a followup of 3.6 years (1.4-6.8). Kaplan-Meier survival analysis further showed significantly worse survival in the rupture cohort (Logrank p=<0.001) (Figure).
The multivariable logistic regression model (C-statistic: 0.80) showed that white race (Odds Ratio (OR): 0.432 (95%CI: 0.216-0.866), p=0.018) was protective for risk of rupture while female sex (OR: 2.269 (1.036-4.971), p=0.041), increased neutrophil-lymphocyte ratio (OR: 1.023 (1.001-1.046), p=0.039) and maximum aneurysm size (OR: 1.703 (1.436-2.020), p<0.001) significantly increased the odds of rupture.
Conclusions: Non-white women with high neutrophil-lymphocyte ratios, CRP, and maximum aneurysm sizes were more predisposed to TAA rupture. Given the poor outcomes associated with aortic rupture, further validation of inflammatory markers and patient demographics as predictors of rupture is needed to define high-risk populations and initiate timely interventions.
Authors
Danial Ahmad (1), Derek Serna-Gallegos (2), Nidhi Iyanna (3), Jack Donohue (4), Yisi Wang (1), Floyd Thoma (1), Sarah Yousef (5), James Brown (1), Julie Phillippi (6), Michel Pompeu Sá (7), Johannes Bonatti (8), David Kaczorowski (9), Pyongsoo Yoon (1), Danny Chu (10), Ibrahim Sultan (2)
Institutions
(1) UPMC, Pittsburgh, PA, (2) University of Pittsburgh Medical Center, Pittsburgh, PA, (3) University of Pittsburgh Medical Center, N/A, (4) N/A, N/A, (5) University of Pittsburgh, Pittsburgh, PA, (6) N/A, Pittsburgh, PA, (7) PROCAPE / University of Pernambuco, Recife, Pernambuco, (8) UPMC Heart and Vascular Institute, Pittsburgh, PA, (9) University of Pittsburgh Medical Center, Venetia, PA, (10) Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
Presentation Duration
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