Long-Term Outcome and Prognosis of Noninfectious Thoracic Aortitis

• DOI: 10.1016/j.jacc.2023.06.031
• Publication Date: 2023-09-04T17:56:39Z
• Authors: Olivier Espitia; Patrick Bruneval; Morgane Assaraf; Jacques Pouchot; Eric Liozon; Hubert de Boysson; Julien Gaudric; Laurent Chiche; Paul Achouh; Jean-Christian Ro...; Sébastien Miranda; Tristan Mirault; Samia Boussouar; Alban Redheuil; Jean-Michel Serfaty; Antoine Bénichou; Christian Agard; Alexis F. Guédon; Patrice Cacoub; François Paraf; Pierre-Jean Fouret; Claire Toquet; Lucie Biard; David Saadoun
• Keywords: Inflammation; Aortic Dissection; Aortitis; Cardiovascular Diseases; Humans; Prognosis; Aorta; 3. Good health

Aortitis is a group of disorders characterized by the inflammation of the aorta. The large-vessel vasculitides are the most common causes of aortitis. Aortitis long-term outcomes are not well known.The purpose of this study was to assess the long-term outcome and prognosis of noninfectious surgical thoracic aortitis.This was a retrospective multicenter study of 5,666 patients with thoracic aorta surgery including 217 (3.8%) with noninfectious thoracic aortitis (118 clinically isolated aortitis, 57 giant cells arteritis, 21 Takayasu arteritis, and 21 with various systemic autoimmune disorders). Factors associated with vascular complications and a second vascular procedure were assessed by multivariable analysis.Indications for aortic surgery were asymptomatic aneurysm with a critical size (n = 152 [70%]), aortic dissection (n = 28 [13%]), and symptomatic aortic aneurysm (n = 30 [14%]). The 10-year cumulative incidence of vascular complication and second vascular procedure was 82.1% (95% CI: 67.6%-90.6%), and 42.6% (95% CI: 28.4%-56.1%), respectively. Aortic arch aortitis (HR: 2.08; 95% CI: 1.26-3.44; P = 0.005) was independently associated with vascular complications. Descending thoracic aortitis (HR: 2.35; 95% CI: 1.11-4.96; P = 0.031) and aortic dissection (HR: 3.08; 95% CI: 1.61-5.90; P = 0.002) were independently associated with a second vascular procedure, while treatment with statins after aortitis diagnosis (HR: 0.47; 95% CI: 0.24-0.90; P = 0.028) decreased it. After a median follow-up of 3.9 years, 19 (16.1%) clinically isolated aortitis patients developed features of a systemic inflammatory disease and 35 (16%) patients had died.This multicenter study shows that 82% of noninfectious surgical thoracic aortitis patients will experience a vascular complication within 10 years. We pointed out specific characteristics that identified those at highest risk for subsequent vascular complications and second vascular procedures.