Journal of the American Heart Association · 2026
Ascending Thoracic Aortic Aneurysms in a Veterans Affairs Health System: Longitudinal Outcomes and Risk Factors.
СтатьяПоддержка NIH: внешняя программаНазвание и аннотация: Перевод пока не подготовлен
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Gomez Axel, Carroway William, Tu Sally, Kailash Vidur, Ge Liang, Boskovski Marko, Tseng Elaine E
Аннотация
BACKGROUND: The decision to perform ascending thoracic aortic aneurysm (ATAA) repair is primarily guided by diameter thresholds, but the optimal timing remains debated. We aimed to analyze ATAA outcomes in a large cohort of veterans.
METHODS: Retrospective cohort study of patients with ATAA with diameter≥4.0 cm under surveillance between 1998 and 2024. Outcomes included surgical repair, all-cause mortality, and aortic events. Fine-Gray competing risks regression evaluated the association of baseline diameter with all-cause mortality, adjusting for age, hypertension, smoking, heart failure, and aortic valve phenotype. Results are reported as adjusted subdistribution hazard ratios (aSHRs) with 95% CIs.
RESULTS: We included 764 veterans (98.0% male) with median (interquartile range) age of 75.0 (9.3) years, and ATAA diameter of 4.40 (0.50) cm. Median follow-up was 5.4 (6.2) years. Surgical repair occurred in 86/764 patients (11.3%). Aortic dissection occurred in 2 patients (0.3%), both within the 4.0 to 4.5 cm group. All-cause mortality rates were 2.83 (2.23-3.59), 3.22 (2.47-4.21), 5.82 (3.91-8.67), and 24.6 (12.2-54.1) deaths per 100 person-years for ATAA diameters 4.0 to 4.4, 4.5 to 4.9, 5.0 to 5.4, and ≥5.5 cm, respectively (P<0.001). In multivariable analysis, all-cause mortality was independently associated with increasing ATAA diameter (aSHR, 1.36 per 0.5cm increase [95% CI, 1.14-1.63]; P<0.001) and increasing age (aSHR, 1.07 per year [95% CI, 1.05-1.09]; P<0.001).
CONCLUSIONS: ATAA all-cause mortality increases with diameter, with a 7-fold incidence increase in aneurysms ≥5.5 cm. Our findings support the 5.5 cm threshold for prophylactic ATAA repair and emphasize the need for selective intervention in smaller aneurysms.
METHODS: Retrospective cohort study of patients with ATAA with diameter≥4.0 cm under surveillance between 1998 and 2024. Outcomes included surgical repair, all-cause mortality, and aortic events. Fine-Gray competing risks regression evaluated the association of baseline diameter with all-cause mortality, adjusting for age, hypertension, smoking, heart failure, and aortic valve phenotype. Results are reported as adjusted subdistribution hazard ratios (aSHRs) with 95% CIs.
RESULTS: We included 764 veterans (98.0% male) with median (interquartile range) age of 75.0 (9.3) years, and ATAA diameter of 4.40 (0.50) cm. Median follow-up was 5.4 (6.2) years. Surgical repair occurred in 86/764 patients (11.3%). Aortic dissection occurred in 2 patients (0.3%), both within the 4.0 to 4.5 cm group. All-cause mortality rates were 2.83 (2.23-3.59), 3.22 (2.47-4.21), 5.82 (3.91-8.67), and 24.6 (12.2-54.1) deaths per 100 person-years for ATAA diameters 4.0 to 4.4, 4.5 to 4.9, 5.0 to 5.4, and ≥5.5 cm, respectively (P<0.001). In multivariable analysis, all-cause mortality was independently associated with increasing ATAA diameter (aSHR, 1.36 per 0.5cm increase [95% CI, 1.14-1.63]; P<0.001) and increasing age (aSHR, 1.07 per year [95% CI, 1.05-1.09]; P<0.001).
CONCLUSIONS: ATAA all-cause mortality increases with diameter, with a 7-fold incidence increase in aneurysms ≥5.5 cm. Our findings support the 5.5 cm threshold for prophylactic ATAA repair and emphasize the need for selective intervention in smaller aneurysms.