End-Stage Acute Thoracic Aortic Care Patients’ Interventions and Two-Year Survival: the New York State Experience

Joshua Helali, Scripps Clinic/Scripps Green Hospital
Annet Kuruvilla, State University of New York at Stony Brook
Ashutosh R. Yaligar, State University of New York at Stony Brook
Daniel H. Wolbrom, State University of New York at Stony Brook
Sohaib Agha, New York Institute of Technology
Jie Yang, State University of New York at Stony Brook
Aurora D. Pryor, State University of New York at Stony Brook
Jonathan Price, State University of New York at Stony Brook
Henry J. Tannous, State University of New York at Stony Brook
Thomas J. Bilfinger, State University of New York at Stony Brook
Allison J. McLarty, State University of New York at Stony Brook
Annie-Laurie W. Shroyer, State University of New York at Stony Brook

Abstract

BACKGROUND:

Scarce US-based regional or State-specific reports exist recording the incidence, prevalence, or post-diagnosis clinical outcomes for end-stage thoracic aortic aneurysmal (TAA) disease. This retrospective cohort study of New York State (NYS) patients with newly diagnosed ruptured or dissected thoracic aortic aneurysms (TAA-RD) documents two-year follow-up after elective and emergent procedures.

METHODS:

Using hospital billing codes, NYS first-time TAA-RD encounters were extracted. As the primary study endpoint, the two-year composite included all-cause death, subsequent rupture or dissection, or non-elective intervention; individual composite sub-components were secondary study endpoints.

Multivariable logistic regression models estimated two-year intervention and composite outcome risks. Using multivariable regression models created for the composite endpoints, post-discharge elective TAA procedural impact was evaluated.

RESULTS:

Of the 5,789 NYS residents identified, 49.92% reached the two-year composite endpoint with 23.98% two-year deaths. Only 1902 (32.86%) of TAA-RD patients had an index intervention. Post-discharge elective TAA interventions dramatically reduced adverse outcome risk (odds ratio [O.R.] = 0.36; 95% confidence interval [C.I.] = 0.26 - 0.51). Multivariable regression models identified patient characteristics associated with the two-year adverse composite outcome including urgent/emergent status, increased Elixhauser comorbidity score, non-rheumatic aortic regurgitation, and carotid disease.

CONCLUSIONS:

Nearly 50% of NYS TAA-RD patients reached the two-year adverse endpoint. Post-2014, the TAA-RD diagnosis rates increased but emergent thoracic aortic surgery rates decreased. Surprisingly, under 50% of NYS TAA-RD patients received an index admission procedure; this rate is lower than anticipated. Beyond traditional morphologic metrics, “at risk” TAA patient-characteristics were identified. Post-discharge survivors had excellent post-procedural two-year durability rates.