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Most people who have an acute dissection of the descending aorta leave hospital alive. But longer term mortality is high. In a recent cohort, almost a quarter (24.9%) of 201 patients died within three years of their index admission. All were recruited from an international register of aortic dissections, and most (146/201, 72.6%) had only medical treatment. The rest had surgery (36/201, 17.9%) or an endovascular procedure such as stenting (19/201, 9.5%)9.5%).
In multivariate analysis, the most important predictor of death was the initial state of the aorta. Men and women with a partial thrombosis of the false lumen were significantly more likely to die than those with a completely patent false lumen (relative risk 2.69, 95% CI 1.45 to 4.98). This new finding was independent of the treatment received in hospital, age, and sex. The findings on patients with a completely thrombosed lumen were insecure because of the small number of patients in this subset.
Partial thrombosis of the lumen was relatively common, occurring in one third of patients in this cohort. The only other independent predictors of poor outcome were a previous history of aortic aneurysm (2.05, 1.07 to 3.93) and documented atherosclerosis (1.87, 1.01 to 3.47).