Abstract：
To describe medical management in aortic dissection (AD) and to analyse the possible associations between antihypertensive, antithrombotic, anticoagulant and statin agents, respectively, and long-term survival.
From Swedish medical registers, all patients diagnosed with AD in 2006-2015 were identified. Filled prescriptions prior to admission and within 1 year from discharge in patients discharged and alive at 30 days were registered. Associations between pharmacological treatment and long-term survival were analysed using Cox proportional hazards models.
Of 3951 patients hospitalised with acute AD, 3046 (77%) were discharged and alive at 30 days. In hospitalised patients, mean age was 66 years (SD 13), and 36% (n=1098) were women. Within 1 year from discharge, 96% (n=2939) had at least one antihypertensive drug. Beta blocker was the most commonly used drug type (90%, n=2741). Statin treatment (47%, n=1418) was associated with higher long-term survival; HR 0.74 (95% CI 0.63 to 0.87, p<0.001). The positive association between statins and long-term survival remained, in subgroup analysis, in medically managed patients (HR 0.72 (95% CI 0.60 to 0.86, p<0.001)), but not in patients undergoing surgical repair (HR 0.82 (95% CI 0.58 to 1.14, p=0.230)). Beta blockers were associated with favourable long-term survival in surgically managed patients (HR 0.58 (95% CI 0.35 to 0.97, p=0.038)) but not in medically managed patients (HR 0.93 (95% CI 0.72 to 1.12, p=0.057)). Neither antiplatelet therapy nor anticoagulants were associated with long-term survival.
Statin treatment was associated with favourable long-term outcome in medically managed AD patients, whereas treatment with beta blocker was associated with higher survival only in surgically managed AD patients. Statin use as well as optimal antihypertensive therapy in the chronic stage of the disease need to be further analysed, preferably in randomised controlled trials.
From Swedish medical registers, all patients diagnosed with AD in 2006-2015 were identified. Filled prescriptions prior to admission and within 1 year from discharge in patients discharged and alive at 30 days were registered. Associations between pharmacological treatment and long-term survival were analysed using Cox proportional hazards models.
Of 3951 patients hospitalised with acute AD, 3046 (77%) were discharged and alive at 30 days. In hospitalised patients, mean age was 66 years (SD 13), and 36% (n=1098) were women. Within 1 year from discharge, 96% (n=2939) had at least one antihypertensive drug. Beta blocker was the most commonly used drug type (90%, n=2741). Statin treatment (47%, n=1418) was associated with higher long-term survival; HR 0.74 (95% CI 0.63 to 0.87, p<0.001). The positive association between statins and long-term survival remained, in subgroup analysis, in medically managed patients (HR 0.72 (95% CI 0.60 to 0.86, p<0.001)), but not in patients undergoing surgical repair (HR 0.82 (95% CI 0.58 to 1.14, p=0.230)). Beta blockers were associated with favourable long-term survival in surgically managed patients (HR 0.58 (95% CI 0.35 to 0.97, p=0.038)) but not in medically managed patients (HR 0.93 (95% CI 0.72 to 1.12, p=0.057)). Neither antiplatelet therapy nor anticoagulants were associated with long-term survival.
Statin treatment was associated with favourable long-term outcome in medically managed AD patients, whereas treatment with beta blocker was associated with higher survival only in surgically managed AD patients. Statin use as well as optimal antihypertensive therapy in the chronic stage of the disease need to be further analysed, preferably in randomised controlled trials.
摘要：
描述主动脉夹层（AD）的医疗管理，并分析抗高血压药之间的可能关联。抗血栓,抗凝剂和他汀类药物，分别,和长期生存。
来自瑞典的医疗登记簿,我们确定了所有在2006-2015年诊断为AD的患者.登记入院前和出院后1年内出院并在30天存活的患者的处方。使用Cox比例风险模型分析药物治疗与长期生存之间的关联。
在3951例急性AD患者中，3046（77％）在30天出院并存活。在住院患者中，平均年龄为66岁（SD13），36％（n=1098）是女性。出院后1年内,96％（n=2939）至少有一种抗高血压药物。β受体阻滞剂是最常用的药物类型(90%，n=2741)。他汀类药物治疗（47%，n=1418）与较高的长期生存率相关；HR0.74（95％CI0.63至0.87，p<0.001）。他汀类药物与长期生存之间的正相关仍然存在，在亚组分析中，在医学管理的患者中（HR0.72（95%CI0.60至0.86，p<0.001）），但在接受手术修复的患者中没有（HR0.82（95％CI0.58至1.14，p=0.230））。在手术管理的患者中，β受体阻滞剂与良好的长期生存率相关（HR0.58（95％CI0.35至0.97，p=0.038）），但在医学管理的患者中却没有（HR0.93（95％CI0.72至1.12，p=0.057））。抗血小板治疗和抗凝剂均与长期生存率无关。
在医学管理的AD患者中，他汀类药物治疗与良好的长期预后相关。而β受体阻滞剂治疗仅在手术管理的AD患者中与较高的生存率相关。他汀类药物的使用以及疾病慢性期的最佳降压治疗需要进一步分析，优选在随机对照试验中。
来自瑞典的医疗登记簿,我们确定了所有在2006-2015年诊断为AD的患者.登记入院前和出院后1年内出院并在30天存活的患者的处方。使用Cox比例风险模型分析药物治疗与长期生存之间的关联。
在3951例急性AD患者中，3046（77％）在30天出院并存活。在住院患者中，平均年龄为66岁（SD13），36％（n=1098）是女性。出院后1年内,96％（n=2939）至少有一种抗高血压药物。β受体阻滞剂是最常用的药物类型(90%，n=2741)。他汀类药物治疗（47%，n=1418）与较高的长期生存率相关；HR0.74（95％CI0.63至0.87，p<0.001）。他汀类药物与长期生存之间的正相关仍然存在，在亚组分析中，在医学管理的患者中（HR0.72（95%CI0.60至0.86，p<0.001）），但在接受手术修复的患者中没有（HR0.82（95％CI0.58至1.14，p=0.230））。在手术管理的患者中，β受体阻滞剂与良好的长期生存率相关（HR0.58（95％CI0.35至0.97，p=0.038）），但在医学管理的患者中却没有（HR0.93（95％CI0.72至1.12，p=0.057））。抗血小板治疗和抗凝剂均与长期生存率无关。
在医学管理的AD患者中，他汀类药物治疗与良好的长期预后相关。而β受体阻滞剂治疗仅在手术管理的AD患者中与较高的生存率相关。他汀类药物的使用以及疾病慢性期的最佳降压治疗需要进一步分析，优选在随机对照试验中。
