Acute aortic dissection was associated with higher 5-year all-cause mortality compared to acute myocardial infarction (50.0% vs. 35.4%; adjusted HR 1.53; 95% CI 1.29-1.83; p<0.001).
Cohort (n=1,923)
Yes
Does acute aortic dissection have a worse long-term prognosis compared to acute myocardial infarction?
Acute aortic dissection is associated with worse 5-year survival than acute myocardial infarction, primarily driven by early deaths, whereas long-term cardiovascular mortality among 30-day survivors is similar.
Effect estimate: adjusted HR 1.53 (95% CI 1.29-1.83)
Absolute Event Rate: 50% vs 35.4%
p-value: p=<0.001
Abstract Background Acute myocardial infarction (AMI) and acute aortic dissection (AAD) are major cardiovascular emergencies with high mortality; however, their long-term prognoses have rarely been directly compared within the same population. Understanding differences in real-world outcomes between these conditions is important for patient informing and evaluation of cardiovascular care. Method We analyzed 1,923 patients enrolled in the Shiga Stroke and Heart Attack Registry, a population-based registry covering an entire Shiga prefecture in Japan, who developed AMI or AAD between 2014 and 2015. The primary outcome was all-cause death and the secondary outcome was cardiovascular death during 5-year follow-up. Hazard ratios (HRs) were estimated using multivariable Cox models adjusted for age and sex. Landmark analyses beyond 30 days evaluated outcomes among early survivors. Results Of the total cohort, 1,550 were AMI (ST-elevation myocardial infarction MI: n=902 58%, non-ST-elevation MI: n=464 30%, and sudden cardiac death due to MI: n=184 12%), and 373 were AAD (type A: n=219 59% and type B: n=154 41%). Five-year all-cause mortality was higher in AAD than AMI (50.0% vs. 35.4%; adjusted HR 1.53, 95% confidence interval CI 1.29–1.83; p0.001). Cardiovascular mortality was also higher in AAD (38.7% vs. 27.4%; adjusted HR 1.41, 95% CI 1.17–1.71; p0.001). Landmark analysis showed that excess mortality in AAD was mainly driven by early deaths, whereas cardiovascular mortality among 30-day survivors was similar between diseases. Conclusions In this population-based study in Japan, AAD was associated with worse 5-year survival than AMI. Among acute-phase survivors, long-term cardiovascular outcomes were comparable.
Sawayama et al. (Fri,) conducted a cohort in Acute myocardial infarction and acute aortic dissection (n=1,923). Acute aortic dissection vs. Acute myocardial infarction was evaluated on all-cause death (adjusted HR 1.53, 95% CI 1.29-1.83, p=<0.001). Acute aortic dissection was associated with higher 5-year all-cause mortality compared to acute myocardial infarction (50.0% vs. 35.4%; adjusted HR 1.53; 95% CI 1.29-1.83; p<0.001).