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AORTIC DISSECTION IN THE ELDERLY: COMPARING SEPTUAGENARIANS AND OCTOGENARIANS
E1518 JACC March 12, 2013 Volume 61, Issue 10
Quality of Care and Outcomes Assessment Aortic Dissection in the Elderly: Comparing Septuagenarians and Octogenarians Poster Contributions Poster Sessions, Expo North Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Aortic, Peripheral Vascular and Non-Cardiac Conditions Abstract Category: 28. Quality of Care and Outcomes Assessment Presentation Number: 1159-109 Authors: Justin Jabara, Mark Peterson, Santi Trimarchi, Truls Myrmel, T. Brett Reece, Eduardo Bossone, Stuart Hutchison, Dan Gilon, Jehangir Appoo, Marco Di Eusanio, Daniel Montgomery, Eric Isselbacher, Christoph Nienaber, Kim Eagle, Himanshu Patel, University of Michigan, Ann Arbor, MI, USA Background: Studies have shown acute aortic dissection (AAD) pts ≥70 years of age have higher in-hospital mortality and less Type A (TA) surgical management (mgmt). These differences may also hold true within the elderly cohort. Methods: We studied 1139 elderly pts from the International Registry of Acute Aortic Dissection, stratified by age (70-79 and 80-89) and AAD type. Results: Type A pts ages 80-89 presented with less chest (73.5% v 84.1%, p=0.002) and back pain (37.1% v 46.9%, p=0.035) than the 70-79 group. Older TA pts had less surgical mgmt (63.7% v 82.2%, p<0.001) but no difference in in-hospital mortality. Surgical TA pts in the 70-79 group had greater 5-year survival (71.3% v 50.7%, p=0.013). Type B (TB) pts in the 80-89 cohort had less abdominal pain (26.9% v 41.7%, p=0.004) and more syncope (7.4% v 2.7%, p=0.026) than those 70-79. TB pts had similar mgmt, but higher in-hospital mortality in older pts with medical mgmt (19.6% v 10.4%, p=0.022) and overall (22.7% v 13.5%, p=0.015). Pts 80-89 with hypotension (in TA), periaortic hematoma (in TB), and atherosclerosis (in TB) had higher in-hospital mortality compared to younger pts with the above conditions. Conclusion: Pts 80-89 described less pain than their younger counterparts. Mortality was higher in older TB pts, but similar for TA pts. Conversely, mgmt differed in TA pts but not in TB. Given a 5-yr survival exceeding 50% in surgically managed pts age 80-89, it appears that age alone should not preclude surgical treatment of selected patients in this age cohort.
Quality of Care and Outcomes Assessment Aortic Dissection in the Elderly: Comparing Septuagenarians and Octogenarians Poster Contributions Poster Sessions, Expo North Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Aortic, Peripheral Vascular and Non-Cardiac Conditions Abstract Category: 28. Quality of Care and Outcomes Assessment Presentation Number: 1159-109 Authors: Justin Jabara, Mark Peterson, Santi Trimarchi, Truls Myrmel, T. Brett Reece, Eduardo Bossone, Stuart Hutchison, Dan Gilon, Jehangir Appoo, Marco Di Eusanio, Daniel Montgomery, Eric Isselbacher, Christoph Nienaber, Kim Eagle, Himanshu Patel, University of Michigan, Ann Arbor, MI, USA Background: Studies have shown acute aortic dissection (AAD) pts ≥70 years of age have higher in-hospital mortality and less Type A (TA) surgical management (mgmt). These differences may also hold true within the elderly cohort. Methods: We studied 1139 elderly pts from the International Registry of Acute Aortic Dissection, stratified by age (70-79 and 80-89) and AAD type. Results: Type A pts ages 80-89 presented with less chest (73.5% v 84.1%, p=0.002) and back pain (37.1% v 46.9%, p=0.035) than the 70-79 group. Older TA pts had less surgical mgmt (63.7% v 82.2%, p<0.001) but no difference in in-hospital mortality. Surgical TA pts in the 70-79 group had greater 5-year survival (71.3% v 50.7%, p=0.013). Type B (TB) pts in the 80-89 cohort had less abdominal pain (26.9% v 41.7%, p=0.004) and more syncope (7.4% v 2.7%, p=0.026) than those 70-79. TB pts had similar mgmt, but higher in-hospital mortality in older pts with medical mgmt (19.6% v 10.4%, p=0.022) and overall (22.7% v 13.5%, p=0.015). Pts 80-89 with hypotension (in TA), periaortic hematoma (in TB), and atherosclerosis (in TB) had higher in-hospital mortality compared to younger pts with the above conditions. Conclusion: Pts 80-89 described less pain than their younger counterparts. Mortality was higher in older TB pts, but similar for TA pts. Conversely, mgmt differed in TA pts but not in TB. Given a 5-yr survival exceeding 50% in surgically managed pts age 80-89, it appears that age alone should not preclude surgical treatment of selected patients in this age cohort.