Adherence to surveillance imaging after aortic dissection linked to mortality, reintervention

A recent study has found poor adherence to guideline-directed imaging surveillance (GDIS) following acute type A aortic dissection (ATAAD), as well as the persistence of substantial long-term mortality and reinterventions.

In this study that defined the real-world frequency of postoperative imaging and characterized long-term outcomes of ATAAD, the authors linked population-based administrative health databases for Ontario, Canada, to identify patients who underwent ATAAD repair and survived at least 90 days.

GDIS was defined as undergoing a computed tomographic or magnetic resonance imaging scan at 6 and 12 months after the procedure and then annually thereafter. Multivariable time-to-event analysis was performed to explore the association of GDIS with all-cause mortality and reintervention.

Overall, 888 patients who survived urgent ATAAD repair between 1 April 2005 and 31 March 2018 participated in the study, with a median follow-up of 5.2 years (interquartile range, 2.4–7.9) after ATAAD repair; 14 percent of patients received GDIS throughout follow-up.

Of the participants, 3.9 percent had received GDIS at 6 years. The mortality rates at 1, 5, and 10 years were 4 percent, 14 percent, and 29 percent, respectively. The incidence of aortic reintervention was 3 percent at 1 year, 9 percent at 5 years, and 17 percent at 10 years; most of these were urgent (68 percent) and had a 30-day mortality rate of 9 percent.

Of note, greater adherence to GDIS correlated with mortality (hazard ratio [HR], 1.08, 95 percent confidence interval [CI], 1.05–1.11) and reintervention (HR, 1.04, 95 percent CI, 1.01–1.07).

“Further research is needed to determine if guidelines should be modified,” the authors said.