Heart and Vessels

, Volume 29, Issue 2, pp 220–230

Thrombocytopenia: an early marker of late mortality in type B aortic dissection

  • Pascal Delsart
  • Jean-Paul Beregi
  • Patrick Devos
  • Stephan Haulon
  • Marco Midulla
  • Claire Mounier-Vehier
Original Article
  • 233 Downloads

Abstract

Mid-term and long-term mortality after aortic dissection remain high and due to unknown factors. To determine predicting factors at the acute phase associated with mid- and long-term all-cause mortality, patients with type B aortic dissection including intramural hematoma, treated in one referral university center in an area with a population of 4 million, were analyzed over a period of 12 years (from 1996 to 2008). Based on the total population, 77 patients discharged after type B aortic dissection (including 11 intramural hematoma) were recorded as treated with either medical treatment alone (n = 41) or with additional endovascular therapy (n = 36). The mean follow-up period was 50.8 months, with a survival rate of 78 % (17 deaths). Patient history, symptoms, medical treatment, biological parameters, imaging, and intervention during acute phase (more than 150 parameters) were analyzed to identify any relationship with complications and death. Kaplan–Meier survival curve and Cox proportional hazards analyses identified independent predictors of follow-up mortality from any cause. Factors influencing mortality (P < 0.05) were a low systolic blood pressure (SBP) at admission, a thrombocytopenia in the acute period, chronic bronchitis, diameter of ascending aorta, and renin–angiotensin system inhibitor intake. Independent predictors of mortality were chronic bronchitis (P = 0.0022, hazard ratio (HR) 17.5), early thrombocytopenia (P = 0.042, HR 3.5), and admission SBP <120 mmHg (P = 0.0048, HR 7.928). Treated (medical ± endovascular) type B aortic dissection held a worse long-term prognosis, which can be correlated with predicting factors, especially in-hospital thrombocytopenia, and should require closer follow-up

Keywords

Aortic dissection Mortality Risk factors Endovascular intervention Medical treatment Thrombocytopenia 

Copyright information

© Springer Japan 2013

Authors and Affiliations

  • Pascal Delsart
    • 1
  • Jean-Paul Beregi
    • 2
  • Patrick Devos
    • 3
  • Stephan Haulon
    • 4
  • Marco Midulla
    • 5
  • Claire Mounier-Vehier
    • 1
  1. 1.Service de Médecine Vasculaire et HTA, Hôpital CardiologiqueCHRU de LilleLille CedexFrance
  2. 2.Radiologie CHU Carémeau, Faculté de Médecine de NîmesCHU de NîmesNimesFrance
  3. 3.CERIMCHU de LilleLille CedexFrance
  4. 4.Chirurgie Vasculaire, Hôpital CardiologiqueCHU de LilleLille CedexFrance
  5. 5.Radiologie Vasculaire, Hôpital CardiologiqueCHU de LilleLille CedexFrance

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