Racial disparities in presentation and short-term outcomes for patients with acute type B aortic dissection

Sorour, Ahmed A.; Kirksey, Levester; Laczynski, David J.; Hoell, Nicholas G.; Bena, James; Kalahasti, Vidyasagar; Roselli, Eric E.; Smolock, Christopher J.; Lyden, Sean P.; Caputo, Francis J.

doi:10.1016/j.jvs.2022.01.010

Cited by 4 publications

(3 citation statements)

References 29 publications

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“…We performed only internal validation by bootstrapping, despite the fact that this model’s internal evaluation revealed excellent calibration and optimal discrimination. External validation, especially from other countries, is lacking given that the clinical manifestations of aortic disease are highly correlated with regional and ethnic differences ( 42 ). Second, the prediction model was constructed retrospectively using observational data.…”

Section: Discussionmentioning

confidence: 99%

Develop ment and validation of a prognostic dynamic nomogram for in-hospital mortality in patients with Stanford type B aortic dissection

Yang

Wang²,

He³

et al. 2023

Front. Cardiovasc. Med.

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BackgroundThis study aimed to identify the risk factors for in-hospital mortality in patients with Stanford type B aortic dissection (TBAD) and develop and validate a prognostic dynamic nomogram for in-hospital mortality in these patients.MethodsThis retrospective study involved patients with TBAD treated from April 2002 to December 2020 at the General Hospital of Northern Theater Command. The patients with TBAD were divided into survival and non-survival groups. The data were analyzed by univariate and multivariate logistic regression analyses. To identify independent risk factors for in-hospital mortality, multivariate logistic regression analysis, least absolute shrinkage, and selection operator regression were used. A prediction model was constructed using a nomogram based on these factors and validated using the original data set. To assess its discriminative ability, the area under the receiver operating characteristic curve (AUC) was calculated, and the calibration ability was tested using a calibration curve and the Hosmer-Lemeshow test. Clinical utility was evaluated using decision curve analysis (DCA) and clinical impact curves (CIC).ResultsOf the 978 included patients, 52 (5.3%) died in hospital. The following variables helped predict in-hospital mortality: pleural effusion, systolic blood pressure ≥160 mmHg, heart rate >100 bpm, anemia, ischemic cerebrovascular disease, abnormal cTnT level, and estimated glomerular filtration rate <60 ml/min. The prediction model demonstrated good discrimination [AUC = 0.894; 95% confidence interval (CI), 0.850–0.938]. The predicted probabilities of in-hospital death corresponded well to the actual prevalence rate [calibration curve: via 1,000 bootstrap resamples, a bootstrap-corrected Harrell’s concordance index of 0.905 (95% CI, 0.865–0.945), and the Hosmer–Lemeshow test (χ2 = 8.3334, P = 0.4016)]. DCA indicated that when the risk threshold was set between 0.04 and 0.88, the predictive model could achieve larger clinical net benefits than “no intervention” or “intervention for all” options. Moreover, CIC showed good predictive ability and clinical utility for the model.ConclusionWe developed and validated prediction nomograms, including a simple bed nomogram and online dynamic nomogram, that could be used to identify patients with TBAD at higher risk of in-hospital mortality, thereby better enabling clinicians to provide individualized patient management and timely and effective interventions.

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Section: Discussionmentioning

confidence: 99%

Develop ment and validation of a prognostic dynamic nomogram for in-hospital mortality in patients with Stanford type B aortic dissection

Yang

Wang²,

He³

et al. 2023

Front. Cardiovasc. Med.

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“…Covariates of interest included age, sex, race (Black, White, or other [Asian, Hispanic, and North American Native individuals and those with other race] or unknown), geographical region, and Medicaid dual eligibility from the Master Beneficiary Summary File; comorbidities derived from inpatient claims based on validated algorithms; and the number of TEVARs performed at the index admission institution in the year before the index admission. Race was obtained from the Master Beneficiary Summary File and was included as a covariate because it has previously been shown to be associated with receipt of TEVAR and TEVAR outcomes after TBAD . Frailty was also included as a covariate using the Claims-Based Frailty Indicator derived from inpatient claims .…”

Section: Methodsmentioning

confidence: 99%

Initial Thoracic Endovascular Aortic Repair vs Medical Therapy for Acute Uncomplicated Type B Aortic Dissection

et al. 2023

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ImportanceThoracic endovascular aortic repair (TEVAR) has increasingly been used for uncomplicated type B aortic dissection (uTBAD) despite limited supporting data.ObjectiveTo assess whether initial TEVAR following uTBAD is associated with reduced mortality or morbidity compared with medical therapy alone.Design, Setting, and ParticipantsThis cohort study included Centers for Medicare &amp; Medicaid Services inpatient claims data for adults aged 65 years or older with index admissions for acute uTBAD from January 1, 2011, to December 31, 2018, with follow-up available through December 31, 2019.ExposuresInitial TEVAR was defined as TEVAR within 30 days of admission for acute uTBAD.Main Outcomes and MeasuresOutcomes included all-cause mortality, cardiovascular hospitalizations, aorta-related and repeated aorta-related hospitalizations, and aortic interventions associated with initial TEVAR vs medical therapy. Propensity score inverse probability weighting was used.ResultsOf 7105 patients with eligible index admissions for acute uTBAD, 1140 (16.0%) underwent initial TEVAR (623 [54.6%] female; median age, 74 years [IQR, 68-80 years]) and 5965 (84.0%) did not undergo TEVAR (3344 [56.1%] female; median age, 76 years [IQR, 69-83 years]). Receipt of TEVAR was associated with region (vs South; Midwest: adjusted odds ratio [aOR], 0.66 [95% CI, 0.53-0.81]; P &lt; .001; Northeast: aOR, 0.63 [95% CI, 0.50-0.79]; P &lt; .001), Medicaid dual eligibility (aOR, 0.76; 95% CI, 0.63-0.91; P = .003), hypertension (aOR, 1.26; 95% CI, 1.03-1.54; P = .03), peripheral vascular disease (aOR, 1.24; 95% CI, 1.02-1.49; P = .03), and year of admission (2012, 2013, 2014, and 2015 were associated with greater odds of TEVAR compared with 2011). After inverse probability weighting, mortality was similar for the 2 strategies up to 5 years (hazard ratio [HR], 0.95; 95% CI, 0.85-1.06), as were aorta-related hospitalizations (HR, 1.12; 95% CI, 0.99-1.27), aortic interventions (HR, 1.01; 95% CI, 0.84-1.20), and cardiovascular hospitalizations (HR, 1.05; 95% CI, 0.93-1.20). In a sensitivity analysis that included deaths within the first 30 days, initial TEVAR was associated with lower mortality over a period of 1 year (adjusted HR [aHR], 0.86; 95% CI, 0.75-0.99; P = .03), 2 years (aHR, 0.85; 95% CI, 0.75-0.96; P = .008), and 5 years (aHR, 0.87; 95% CI, 0.80-0.96; P = .004).Conclusions and RelevanceIn this study, 16.0% of patients underwent initial TEVAR within 30 days of uTBAD, and receipt of initial TEVAR was associated with hypertension, peripheral vascular disease, region, Medicaid dual eligibility, and year of admission. Initial TEVAR was not associated with improved mortality or reduced hospitalizations or aortic interventions over a period of 5 years, but in a sensitivity analysis that included deaths within the first 30 days, initial TEVAR was associated with lower mortality. These findings, along with cost-effectiveness and quality of life, should be assessed in a prospective trial in the US population.

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“…Nevertheless, statistical differences were not observed between in-hospital and 3-year mortality [70] . Sorour et al’s study of 180 patients with acute-type B aortic dissection revealed a considerably younger cohort (58.9 vs. 67.6 years), a more refractory hypertension rate (42.2% vs. 16.4%), poorer compliance to treatment (72.9% vs. 93.3%), and more frequent emergency department usage before onset (57.9% vs. 26.9%) among Black patients, although dissection morphology and clinical outcome were similar [71] . Harris et al found that this phenomenon was dramatically evident among non-White residents in Maryland, USA [72] .…”

Section: Race-based Differencesmentioning

confidence: 99%

Aortic dissection: global epidemiology

et al. 2022

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Aortic dissection is a highly fatal disease with limited predictability requiring emergency response. It remains a challenging clinical problem and has a reported lower 5-year survival rate, especially in acute cases. Studying the epidemiology of aortic dissection can be important for targeting key populations and developing public health policies. Past studies have focused more on the in-hospital and follow-up mortality associated with aortic dissection but the global epidemiology review is still lacking. Incidence data have rarely been generated or provided. We estimated and analyzed the incidence of aortic dissection in all 195 countries and 54 regions worldwide and in the population structures of 15 selected countries. We further reviewed risk factors and baseline characteristics related to aortic dissection. We outlined the topic in terms of the biological, social, environmental, and psychosocial factors. Public health departments should screen target groups and key regions and introduce policies for disease prevention and relieve the high medical burdens.

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Racial disparities in presentation and short-term outcomes for patients with acute type B aortic dissection

Cited by 4 publications

References 29 publications

Develop ment and validation of a prognostic dynamic nomogram for in-hospital mortality in patients with Stanford type B aortic dissection

Develop ment and validation of a prognostic dynamic nomogram for in-hospital mortality in patients with Stanford type B aortic dissection

Initial Thoracic Endovascular Aortic Repair vs Medical Therapy for Acute Uncomplicated Type B Aortic Dissection

Aortic dissection: global epidemiology

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