After acute type A aortic dissection (ATAAD) repair, a population-based retrospective cohort study found that adherence to guideline-directed imaging surveillance (GDIS) was low and rates of reintervention and long-term mortality were high. These findings were published in the Canadian Journal of Cardiology.

Between 2005 and 2018, all patients who underwent ATAAD repair in Ontario, Canada (N=888) were assessed for GDIS, reintervention, and mortality. GDIS was defined as undergoing a computed tomography or magnetic resonance scan of the chest at 6 and 12 months following ATAAD repair and yearly after the first 12 months.

Patients were aged median 61 (interquartile range [IQR], 51-71) years, 70.3% were men, 65.1% had hypertension, and 25.8% dyslipidemia.


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At 90 days, 100% of patients had undergone GDIS. At year 2, 742 patients had survived among whom, the proportion of patients who underwent GDIS dropped to 20.6%. As time progressed, fewer and fewer patients underwent GDIS. At year 8, fewer than 5 patients (£2.1%) had an imaging follow-up.

The mortality rate at year 1 was 4%, increasing to 14% at year 5, and 29% at year 10. The reintervention rate at year 1 was 3%, increasing to 9% at year 5, and 17% at year 10.

Among patients who had a reintervention, 68% were urgent.

A 10% increase in the time of adherence to GDIS was associated with mortality (hazard ratio [HR], 1.08; 95% CI, 1.05-1.11) and reintervention (HR, 1.04; 95% CI, 1.01-1.07) rates using a time-varying definition of compliance.

Mortality risk was increased among patients with chronic kidney disease (HR, 1.97; 95% CI, 1.01-3.86), among those who lived in the lowest quintile of neighborhood income (HR, 1.61; 95% CI, 1.01-2.57), had higher Charlson comorbidity index (HR, 1.29; 95% CI, 1.10-1.50), and age (HR, 1.05; 95% CI, 1.03-1.07) and was decreased among women (HR, 0.66; 95% CI, 0.45-0.95).

Reintervention was less likely among women (HR, 0.54; 95% CI, 0.31-0.93) and older individuals (HR, 0.97; 95% CI, 0.96-0.99).

This study was limited as the investigators had no access to information about the type of ATAAD repair.

A review of these guidelines is likely needed in order to assess more effective methods for increasing surveillance among the most at-risk patients.

Reference

An KR, de Mestral C, Tam DY, et al. Surveillance imaging following acute type A aortic dissection. Can J Cardiol. 2021;37(10):S103-S104. doi:10.1016/j.cjca.2021.07.200