Clinical Investigation of Recurrent Arterial Dissection

Abstract

Background: Recurrent arterial dissection (RAD) after thoracic aortic dissection is poorly understood. Methods: We used the Research Patient Data Registry (RPDR) tool to identify 954 patients with acute, imaging-confirmed, thoracic aortic dissection. We characterised dissection anatomy and elucidated the prevalence and incidence of cardiovascular risk factors and events prior to and in the peri-dissection period based on ICD-9 codes. We compared these findings between patients who experienced RAD versus a single thoracic aortic dissection (SAD). Results: RAD occurred in 117 patients (12.3 %). RAD patients were younger (49.21 ± 15.65 years vs 63.20 ± 15.19 years, p < 0.0001), more likely to be male (73.5 % vs 64.8 %, p = 0.0476), more likely to have Stanford Type A dissection (77.8 % vs 57.1 %, p < 0.0001) and more likely to have extension of dissection flap into the cervical arteries (25.0 % vs 15.0 %, p = 0.0207). Prior to dissection, RAD patients were less likely to have a history of hypertension (29.1 % vs 53.5 %, p < 0.0001), diabetes mellitus (2.56 % vs 7.77 %, p = 0.0355), dyslipidaemia (12.0 % vs 23.2 %, p = 0.0041), cerebrovascular accident (6.84 % vs 14.2 %, p = 0.0223), heart failure (5.98 % vs 18.5 %, p = 0.0005), disorders of the mitral valve (4.27 % vs 11.2 %, p = 0.0172), disorders of the aortic valve (12.8 % vs 25.7 %, p = 0.0014) and atrial fibrillation (4.27 % vs 16.1 %, p = 0.0005), but were more likely to have Marfan syndrome (26.5 % vs 4.30 %, p < 0.0001). RAD patients also had a lower incidence of new hypertension (13.3 % vs 49.4 %, p < 0.0001), diabetes mellitus (0 % vs 4.53 %, p = 0.0200), dyslipidaemia (0.97 % vs 14.0 %, p = 0.0001), first-time cerebrovascular accident (3.67 % vs 11.8 %, p = 0.0088), heart failure (7.27 % vs 20.1 %, p = 0.0008) and disorders of the mitral valve (2.68 % vs 11.3 %, p = 0.0039) in the first 30 days after thoracic aortic dissection. Most RAD events consisted of recurrent aortic dissection (88.0 %). Conclusions: The first 30 days following thoracic aortic dissection is a perilous time with a high incidence of new cardiovascular events in previously healthy patients. RAD may be a marker for underlying aberrations in vascular connective tissue integrity.