Association Between Preoperative Monocyte to High-Density Lipoprotein Ratio on In-hospital and Long-Term Mortality in Patients Undergoing Endovascular Repair for Acute Type B Aortic Dissection

Abstract

Aims: The monocyte to high-density lipoprotein ratio (MHR), a novel marker of inflammation and cardiovascular events, has recently been found to facilitate the diagnosis of acute aortic dissection. This study aimed to assess the association of preoperative MHR with in-hospital and long-term mortality after thoracic endovascular aortic repair (TEVAR) for acute type B aortic dissection (TBAD).Methods: We retrospectively evaluated 637 patients with acute TBAD who underwent TEVAR from a prospectively maintained database. Multivariable logistic and cox regression analyses were conducted to assess the relationship between preoperative MHR and in-hospital as well as long-term mortality. For clinical use, MHR was modeled as a continuous variable and a categorical variable with the optimal cutoff evaluated by receiver operator characteristic curve for long-term mortality. Propensity score matching was used to diminish baseline differences and subgroups analyses were conducted to assess the robustness of the results.Results: Twenty-one (3.3%) patients died during hospitalization and 52 deaths (8.4%) were documented after a median follow-up of 48.1 months. The optimal cutoff value was 1.13 selected according to the receiver operator characteristic curve (sensitivity 78.8%; specificity 58.9%). Multivariate analyses showed that MHR was independently associated with either in-hospital death [odds ratio (OR) 2.11, 95% confidence interval (CI) 1.16-3.85, P = 0.015] or long-term mortality [hazard ratio (HR) 1.78, 95% CI 1.31-2.41, P < 0.001). As a categorical variable, MHR > 1.13 remained an independent predictor of in-hospital death (OR 4.53, 95% CI 1.44-14.30, P = 0.010) and long-term mortality (HR 4.16, 95% CI 2.13-8.10, P < 0.001). Propensity score analyses demonstrated similar results for both in-hospital death and long-term mortality. The association was further confirmed by subgroup analyses.Conclusions: MHR might be useful for identifying patients at high risk of in-hospital and long-term mortality, which could be integrated into risk stratification strategies for acute TBAD patients undergoing TEVAR.

Coronary artery disease as an independent predictor of short-term and long-term outcomes in patients with type-B aortic dissection undergoing thoracic endovascular repair

“…In the present study, CAD was significantly associated with increased risk of in-hospital MACE in patients with TBAD undergoing TEVAR, which was driven primarily by stroke and limb ischemia. The stroke rate (2.2%) and limb ischemia rate (3.0%) in our study were comparable with that reported in previous studies (24)(25)(26)(27). Furthermore, our study indicated that TBAD patients with CAD significantly had higher rates of CKD and stroke history as well as higher average age than patients without CAD.…”

Monocyte to high‐density lipoprotein ratio as a predictive biomarker for in‐hospital mortality following surgery for type A aortic dissection: Reality or myth?

“…6 This study is the first in the literature to investigate the prognostic relationship between MHR and TAAD, yet, MHR has been linked with myocardial infarction as well as bicuspid aortic valve degeneration, proving to be a useful tool in tackling the cardiovascular disease. [6][7][8] Xie et al 9 studied and confirmed MHR as a biomarker for in-hospital and long-term mortality in patients undergoing endovascular repair for acute type b AD. Additionally, Du et al 10 looked at the diagnostic value of MHR in acute AD, providing further evidence in its favor.…”

Risk profile analysis of uncomplicated type B aortic dissection patients undergoing thoracic endovascular aortic repair: Laboratory and radiographic predictors

“…e Predictive of postdischarge mortality. ratio, 64,65 and long ncRNAs (e.g., LUCAT1) 66 -have all been suggested and further study in these areas is warranted.…”

“…There seems to be growing evidence for the role of these novel serologic markers in predicting the development of thoracic aortic aneurysm—many of these are elusive based on small sample studies although CRP and transforming growth factor beta appear to be of value 62 . More recently, immunological metrics—such as neutrophil‐lymphocyte ratio (NLR), 63 monocyte to high‐density lipoprotein ratio, 64,65 and long ncRNAs (e.g., LUCAT1) 66 —have all been suggested and further study in these areas is warranted.…”