From the Guidelines
Aortic dissection is associated with a high mortality rate, with approximately 20-30% of patients dying before reaching the hospital, and the mortality rate varies depending on the type of dissection and treatment approach, with Type A dissections having a mortality rate of about 1-2% per hour within the first 48 hours if left untreated 1.
Mortality Rates
The mortality rate for aortic dissection is high, with a significant portion of patients dying before receiving medical care. For those who do receive medical care, the mortality rate varies depending on the type of dissection and treatment approach.
- Type A dissections (involving the ascending aorta) have a mortality rate of about 1-2% per hour within the first 48 hours if left untreated, with an overall mortality rate of 25-30% even with prompt surgical intervention 1.
- Type B dissections (affecting only the descending aorta) have a lower initial mortality rate of about 10% with medical management alone 1.
Factors Affecting Mortality
Several factors can increase mortality in patients with aortic dissection, including:
- Advanced age
- Delayed diagnosis
- Presence of complications like malperfusion syndromes, rupture, and pre-existing conditions such as hypertension and atherosclerosis 1
Treatment Approach
Immediate surgical intervention for Type A dissections and appropriate medical management with blood pressure control for uncomplicated Type B dissections are essential to improve survival outcomes.
- Blood pressure should typically be maintained between 100-120 mmHg systolic using beta-blockers like labetalol or esmolol as first-line agents, often combined with other antihypertensives as needed 1.
Long-term Survival Rates
Long-term survival rates for patients with aortic dissection show that approximately 60-80% of treated patients survive to 5 years, though this decreases to 40-50% at 10 years 1.
From the Research
Mortality Rates in Aortic Dissection
- The mortality rate for acute type A aortic dissection can be as high as 1% per hour if not managed promptly, but with advancements in clinical practice, it has been reduced to below 30% in most international centers 2.
- For uncomplicated type B aortic dissections, the mortality rates at 30 days and 2 years were similar between patients who underwent thoracic endovascular aortic repair (TEVAR) with best medical therapy (BMT) and those who received BMT alone, with rates of 6.5% vs 4.8% and 9.7% vs 11.9%, respectively 3.
- The use of oral beta-blockers was associated with significant protection against in-hospital mortality and stroke following repair in patients with nontraumatic type B aortic dissection, with a mortality rate of 7.9% vs 16.7% in the open surgical repair group and 3.3% vs 9.2% in the endovascular group 4.
Factors Affecting Mortality
- Age, extent of the pathology, existence of connective tissue disorders, hypertension, diabetes mellitus, and surgeon experience can significantly affect outcomes in acute type A aortic dissection 2.
- The use of beta-blockers, particularly metoprolol, was associated with improved survival in patients with nontraumatic type B aortic dissection, with a dose of ≤10 mg associated with significant mortality reduction 4.
- Statin treatment was associated with higher long-term survival in medically managed patients with aortic dissection, with a hazard ratio of 0.74 (95% CI 0.63 to 0.87, p<0.001) 5.
Treatment Outcomes
- There is no randomized controlled trial evidence to support the current guidelines recommending the use of beta-blockers as first-line treatment for chronic type B aortic dissection 6.
- Beta blockers were associated with favorable long-term survival in surgically managed patients, but not in medically managed patients, with a hazard ratio of 0.58 (95% CI 0.35 to 0.97, p=0.038) 5.
- Neither antiplatelet therapy nor anticoagulants were associated with long-term survival in patients with aortic dissection 5.