IRAD Study Compares Long-Term Mortality Rates for TEVAR and Medical Therapy in Treatment of Type B Acute Aortic Dissection

August 19, 2013—An evaluation of long-term survival after thoracic endovascular aortic repair (TEVAR) in patients with type B acute aortic dissection (TBAAD) in the International Registry of Acute Aortic Dissection (IRAD) was published by Rossella Fattori, MD, et al in the Journal of the American College of Cardiology: Cardiovascular Interventions (JACC: CI; 2013;6:876–882).

The IRAD investigators concluded that TEVAR is associated with lower mortality over a 5-year period than medical therapy for TBAAD. They advised that further randomized trials with long-term follow-up are needed.

The background of the study is that although historical data have supported medical therapy in patients with TBAAD, recent advances in TEVAR appear to improve in-hospital mortality, noted the investigators.

As summarized in JACC: CI, the study investigators examined 1,129 consecutive patients with TBAAD enrolled in IRAD between 1995 and 2012. The patients received TEVAR (n = 276, 24.4%) or medical therapy (n = 853, 75.6%).

The investigators found that clinical history was similar between groups. TEVAR patients versus medical therapy were more likely to present with a pulse deficit (28.3% vs 13.4%; P < .001) and lower extremity ischemia (16.8% vs 3.6%; P < .001), and to characterize their pain as the “worst pain ever” (27.5% vs 15.7%; P < .001). TEVAR patients were also most likely to present with complicated acute aortic dissection, defined as shock, periaortic hematoma, signs of malperfusion, stroke, spinal cord ischemia, mesenteric ischemia, and/or renal failure (61.7% vs 37.2%).

In-hospital mortality was similar in patients managed with TEVAR compared with medically managed patients (10.9 % vs 8.7%; P = .273). One-year mortality was also similar in both groups (8.1% vs 9.8%; P = .604).

Aortic growth/new aneurysm was the most common adverse event during follow-up in both the TEVAR and medical therapy groups based on 5-year Kaplan-Meier estimates (62.7% vs 73.3%). Kaplan-Meier survival estimates showed that patients undergoing TEVAR had a lower death rate than medical therapy patients at 5 years (15.5% vs 29%; P = .018), reported the IRAD investigators in JACC: CI.