Cardiovascular morbidity and mortality after aortic dissection, intramural hematoma, and penetrating aortic ulcer

Salome Weiss, Indrani Sen, Ying Huang, Jill M. Killian, W. Scott Harmsen, Jayawant Mandrekar, Alanna Chamberlain, Philip P. Goodney, Veronique Lee Roger, Randall R De Martino

Research output: Contribution to journalArticle

Abstract

Objective: The nonaortic cardiovascular morbidity and mortality of patients with aortic dissection (AD), intramural hematoma (IMH), and penetrating aortic ulcer (PAU) is unknown. We aimed to define the rates of cardiovascular (CV) events in a cohort of patients with newly diagnosed AD, IMH, and PAU. Methods: We performed a retrospective review of all Olmsted County, Minnesota, residents diagnosed with AD, IMH, and PAU from 1995 to 2015. The primary outcome was nonaortic CV death. The secondary outcome was a first-time nonfatal CV event (myocardial infarction, heart failure [HF], or stroke). The outcomes were compared with age- and sex-matched population referents using Cox proportional hazards regression, with adjustment for comorbidities. Results: A total of 133 patients (77 with AD, 21 with IMH, 35 with PAU; 57% male) with a mean age of 71.8 ± 14.1 years were identified. The median follow-up was 10 years. Compared with the population referents, the patients with AD/IMH/PAU had an increased risk of CV death (adjusted hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.4-4.2; P =.003) and an increased risk of any first-time nonfatal CV event (adjusted HR, 3.0; 95% CI, 1.9-4.8; P <.001), mainly resulting from an increased risk of first-time HF (adjusted HR, 2.7; 95% CI, 1.7-4.3; P <.001). When excluding events within 14 days of the diagnosis, the patients with AD/IMH/PAU remained at increased risk of CV death (adjusted HR, 2.6; 95% CI, 1.4-4.7; P =.002), any first-time nonfatal CV event (adjusted HR, 2.6; 95% CI, 1.5-4.4, P <.001), and first-time HF (adjusted HR 2.5, 95% CI 1.5-4.3; P <.001). Conclusions: Compared with the population referents, the patients with AD/IMH/PAU had a two- to threefold risk of nonaortic CV death, any first-time nonfatal CV event, and first-time HF. These data implicate the need for long-term cardiovascular management for patients with AD/IMH/PAU.

Original languageEnglish (US)
JournalJournal of vascular surgery
DOIs
StatePublished - Jan 1 2019

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Hematoma
Ulcer
Dissection
Morbidity
Mortality
Confidence Intervals
Heart Failure
Population
Comorbidity
Stroke
Myocardial Infarction

Keywords

  • Aorta
  • Aortic disease
  • Cardiovascular death
  • Cardiovascular events
  • Cardiovascular risk

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Cardiovascular morbidity and mortality after aortic dissection, intramural hematoma, and penetrating aortic ulcer. / Weiss, Salome; Sen, Indrani; Huang, Ying; Killian, Jill M.; Harmsen, W. Scott; Mandrekar, Jayawant; Chamberlain, Alanna; Goodney, Philip P.; Roger, Veronique Lee; De Martino, Randall R.

In: Journal of vascular surgery, 01.01.2019.

Research output: Contribution to journalArticle

@article{500345a67d274682ac506cf1b442cb41,
title = "Cardiovascular morbidity and mortality after aortic dissection, intramural hematoma, and penetrating aortic ulcer",
abstract = "Objective: The nonaortic cardiovascular morbidity and mortality of patients with aortic dissection (AD), intramural hematoma (IMH), and penetrating aortic ulcer (PAU) is unknown. We aimed to define the rates of cardiovascular (CV) events in a cohort of patients with newly diagnosed AD, IMH, and PAU. Methods: We performed a retrospective review of all Olmsted County, Minnesota, residents diagnosed with AD, IMH, and PAU from 1995 to 2015. The primary outcome was nonaortic CV death. The secondary outcome was a first-time nonfatal CV event (myocardial infarction, heart failure [HF], or stroke). The outcomes were compared with age- and sex-matched population referents using Cox proportional hazards regression, with adjustment for comorbidities. Results: A total of 133 patients (77 with AD, 21 with IMH, 35 with PAU; 57{\%} male) with a mean age of 71.8 ± 14.1 years were identified. The median follow-up was 10 years. Compared with the population referents, the patients with AD/IMH/PAU had an increased risk of CV death (adjusted hazard ratio [HR], 2.4; 95{\%} confidence interval [CI], 1.4-4.2; P =.003) and an increased risk of any first-time nonfatal CV event (adjusted HR, 3.0; 95{\%} CI, 1.9-4.8; P <.001), mainly resulting from an increased risk of first-time HF (adjusted HR, 2.7; 95{\%} CI, 1.7-4.3; P <.001). When excluding events within 14 days of the diagnosis, the patients with AD/IMH/PAU remained at increased risk of CV death (adjusted HR, 2.6; 95{\%} CI, 1.4-4.7; P =.002), any first-time nonfatal CV event (adjusted HR, 2.6; 95{\%} CI, 1.5-4.4, P <.001), and first-time HF (adjusted HR 2.5, 95{\%} CI 1.5-4.3; P <.001). Conclusions: Compared with the population referents, the patients with AD/IMH/PAU had a two- to threefold risk of nonaortic CV death, any first-time nonfatal CV event, and first-time HF. These data implicate the need for long-term cardiovascular management for patients with AD/IMH/PAU.",
keywords = "Aorta, Aortic disease, Cardiovascular death, Cardiovascular events, Cardiovascular risk",
author = "Salome Weiss and Indrani Sen and Ying Huang and Killian, {Jill M.} and Harmsen, {W. Scott} and Jayawant Mandrekar and Alanna Chamberlain and Goodney, {Philip P.} and Roger, {Veronique Lee} and {De Martino}, {Randall R}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jvs.2018.12.031",
language = "English (US)",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
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T1 - Cardiovascular morbidity and mortality after aortic dissection, intramural hematoma, and penetrating aortic ulcer

AU - Weiss, Salome

AU - Sen, Indrani

AU - Huang, Ying

AU - Killian, Jill M.

AU - Harmsen, W. Scott

AU - Mandrekar, Jayawant

AU - Chamberlain, Alanna

AU - Goodney, Philip P.

AU - Roger, Veronique Lee

AU - De Martino, Randall R

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: The nonaortic cardiovascular morbidity and mortality of patients with aortic dissection (AD), intramural hematoma (IMH), and penetrating aortic ulcer (PAU) is unknown. We aimed to define the rates of cardiovascular (CV) events in a cohort of patients with newly diagnosed AD, IMH, and PAU. Methods: We performed a retrospective review of all Olmsted County, Minnesota, residents diagnosed with AD, IMH, and PAU from 1995 to 2015. The primary outcome was nonaortic CV death. The secondary outcome was a first-time nonfatal CV event (myocardial infarction, heart failure [HF], or stroke). The outcomes were compared with age- and sex-matched population referents using Cox proportional hazards regression, with adjustment for comorbidities. Results: A total of 133 patients (77 with AD, 21 with IMH, 35 with PAU; 57% male) with a mean age of 71.8 ± 14.1 years were identified. The median follow-up was 10 years. Compared with the population referents, the patients with AD/IMH/PAU had an increased risk of CV death (adjusted hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.4-4.2; P =.003) and an increased risk of any first-time nonfatal CV event (adjusted HR, 3.0; 95% CI, 1.9-4.8; P <.001), mainly resulting from an increased risk of first-time HF (adjusted HR, 2.7; 95% CI, 1.7-4.3; P <.001). When excluding events within 14 days of the diagnosis, the patients with AD/IMH/PAU remained at increased risk of CV death (adjusted HR, 2.6; 95% CI, 1.4-4.7; P =.002), any first-time nonfatal CV event (adjusted HR, 2.6; 95% CI, 1.5-4.4, P <.001), and first-time HF (adjusted HR 2.5, 95% CI 1.5-4.3; P <.001). Conclusions: Compared with the population referents, the patients with AD/IMH/PAU had a two- to threefold risk of nonaortic CV death, any first-time nonfatal CV event, and first-time HF. These data implicate the need for long-term cardiovascular management for patients with AD/IMH/PAU.

AB - Objective: The nonaortic cardiovascular morbidity and mortality of patients with aortic dissection (AD), intramural hematoma (IMH), and penetrating aortic ulcer (PAU) is unknown. We aimed to define the rates of cardiovascular (CV) events in a cohort of patients with newly diagnosed AD, IMH, and PAU. Methods: We performed a retrospective review of all Olmsted County, Minnesota, residents diagnosed with AD, IMH, and PAU from 1995 to 2015. The primary outcome was nonaortic CV death. The secondary outcome was a first-time nonfatal CV event (myocardial infarction, heart failure [HF], or stroke). The outcomes were compared with age- and sex-matched population referents using Cox proportional hazards regression, with adjustment for comorbidities. Results: A total of 133 patients (77 with AD, 21 with IMH, 35 with PAU; 57% male) with a mean age of 71.8 ± 14.1 years were identified. The median follow-up was 10 years. Compared with the population referents, the patients with AD/IMH/PAU had an increased risk of CV death (adjusted hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.4-4.2; P =.003) and an increased risk of any first-time nonfatal CV event (adjusted HR, 3.0; 95% CI, 1.9-4.8; P <.001), mainly resulting from an increased risk of first-time HF (adjusted HR, 2.7; 95% CI, 1.7-4.3; P <.001). When excluding events within 14 days of the diagnosis, the patients with AD/IMH/PAU remained at increased risk of CV death (adjusted HR, 2.6; 95% CI, 1.4-4.7; P =.002), any first-time nonfatal CV event (adjusted HR, 2.6; 95% CI, 1.5-4.4, P <.001), and first-time HF (adjusted HR 2.5, 95% CI 1.5-4.3; P <.001). Conclusions: Compared with the population referents, the patients with AD/IMH/PAU had a two- to threefold risk of nonaortic CV death, any first-time nonfatal CV event, and first-time HF. These data implicate the need for long-term cardiovascular management for patients with AD/IMH/PAU.

KW - Aorta

KW - Aortic disease

KW - Cardiovascular death

KW - Cardiovascular events

KW - Cardiovascular risk

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