Aortic & peripheral vascular disease
Fate of the unoperated ascending thoracic aortic aneurysm: three-decade experience from the Aortic Institute at Yale University
Authors' conclusion
An aortic size of 5 cm, rather than 5.5 cm, may be a more appropriate intervention criterion for prophylactic ATAA repair. Aortic growth may not be an applicable indicator for intervention.
Study context
- Population
- Unoperated ascending thoracic aortic aneurysm patients, Aortic Institute at Yale University
- Participants
- 964 participants
- Exposure
- Aortic size categories in unoperated ascending thoracic aortic aneurysm (ATAA)
- Outcome
- Adverse aortic events:
- AAE: dissection
- Rupture
- Aortic death
- Follow-up
- Median 7.9 (max 34) years
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
AAE by aortic size
| Group | Average yearly adverse aortic events (AAE) risk | 10-year AAE-free survival |
|---|---|---|
| 3.5-3.9 cm | 0.2% | 97.8% |
| 4.0-4.4 cm | 0.2% | 98.2% |
| 4.5-4.9 cm | 0.3% | 97.3% |
| 5.0-5.4 cm | 1.4% | 84.6% |
| 5.5-5.9 cm | 2.0% | 80.4% |
| ≥6.0 cm | 3.5% | 70.9% |
Average yearly adverse aortic events (AAE) risk
3.5-3.9 cm0.2%
4.0-4.4 cm0.2%
4.5-4.9 cm0.3%
5.0-5.4 cm1.4%
5.5-5.9 cm2.0%
≥6.0 cm3.5%
10-year AAE-free survival
3.5-3.9 cm97.8%
4.0-4.4 cm98.2%
4.5-4.9 cm97.3%
5.0-5.4 cm84.6%
5.5-5.9 cm80.4%
≥6.0 cm70.9%
- Risk of AAE relatively flat until 5 cm, then increased rapidly
- P for non-linearity <0.001
Observational data: associations, not effects.
Further findings
Independent risk factors for AAE (multivariable Cox regression)
| HR (95% CI) | P value | ||
|---|---|---|---|
| Aortic sizeMultivariable | 1.78 (1.50–2.11) | P < 0.001 | |
| AgeMultivariable | 1.02 (1.00–1.05) | P = 0.015 | |
| HyperlipidemiaProtective; univariable Cox regression | 0.46 (0.23–0.91) | P = 0.025 | |
| 0.20.5125Hazard ratio (log scale) |
Mean annual aortic growth rate
- Mean annual growth rate 0.10 ± 0.01 cm/year; growth over 0.2 cm/year rarely seen
Original publication
Fate of the unoperated ascending thoracic aortic aneurysm: three-decade experience from the Aortic Institute at Yale University. Eur Heart J. Published 30 March 2023. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →