Effect of β-blocker therapy on late outcomes after surgical repair of type A aortic dissection

Abstract

Objective: The objective of the study was to evaluate the effects of β-blocker therapy on long-term outcomes in patients after surgical repair of type A aortic dissection.

Methods: A total of 4275 patients with acute type A aortic dissection who underwent surgical repair between 2004 and 2013, were identified using the Taiwan National Health Insurance Research Database. A 1-year observational interval since discharge was used to determine β-blocker usage and medication adherence in survivors. β-Blocker usage was defined as medication prescription within 1 year. All others were defined as non-β-blocker users. Propensity score matching analysis was performed. The primary outcome was all-cause mortality. Secondary outcomes were major adverse cardiac and cerebral events, aortic reoperation, and readmission for any cause.

Results: A total of 396 patients of each group were deemed eligible for analysis. The risk of all-cause mortality was lower in the β-blocker group compared with the non-β-blocker group (16.2% vs 23.7%; hazard ratio, 0.65; 95% confidence interval, 0.47-0.89). The risk of major adverse cardiac and cerebral events was lower in the β-blocker group compared with the non-β-blocker group (19.2% vs 29.0%; hazard ratio, 0.61; 95% confidence interval, 0.46-0.82). Survival curves of β-blocker users were compared according to number of prescription days and showed that more days of β-blocker usage was associated with a lower risk of mortality (adjusted P for linear trend < .001).

Conclusions: β-Blocker usage had a protective effect on long-term outcomes in patients after surgical repair of acute type A aortic dissection. Strict medication adherence of β-blocker therapy was associated with a survival benefit.

Keywords: late outcomes; surgery; type A aortic dissection; β-blockers.