Aortic dissection prognosis is not determined by anatomy alone: early malperfusion, shock, inflammatory activation, renal injury, and false-lumen remodeling sharply define survival risk. This review maps 173 references to show which clinical, biomarker, genetic, and imaging signals can guide urgent triage, TEVAR/open-surgery strategy, and long-term surveillance intensity.
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Abstract: This review aims to synthesize current evidence regarding the prognostic factors associated with aortic dissection, focusing on clinical, biochemical, genetic, and imaging-based predictors of short- and long-term outcomes. The review cites 173 references drawn from 540 included records, including 502 original studies with 782518 total participants (topic deduplicated ΣN). The mapped evidence indicates that prognosis in aortic dissection is dominated by early malperfusion burden, hemodynamic instability, and systemic inflammatory activation, with reported in-hospital mortality spanning roughly 3% in stable surgical cohorts to over 50% in non-surgically managed type A disease and reaching 85.7% when two or more organ systems are malperfused. Stanford classification and treatment pathway remained powerful prognostic anchors, with type A in-hospital mortality of 11.8% with surgery versus 49.7% without surgery, and type B disease showing aorta-specific mortality of 6.9% with thoracic endovascular aortic repair versus 19.3% with medical therapy alone. Recurrent signals across topics support a role for inflammatory indices such as neutrophil-to-lymphocyte ratio above 6.0, coagulation and nutritional markers, lactate dynamics, and false lumen geometry, including a residual descending false lumen diameter of at least 28 mm, as practical stratifiers of short- and long-term risk. Imaging-derived features such as periaortic fat attenuation index, deep-learning-derived false lumen volumes, and patient-specific wall stress modeling further refine remodeling prediction beyond conventional diameter thresholds. Clinically, this evidence map supports integrating rapid biomarker-based triage, structured risk scores, and volumetric imaging surveillance into routine dissection care, while acknowledging that the predominantly retrospective single-center character of the included literature limits the strength of these signals. Future research should prioritize prospective multicenter validation of multimodal prognostic models that combine genetic, inflammatory, nutritional, and geometric predictors to personalize surgical timing, endovascular strategy selection, and long-term surveillance intensity.
Final search date and database lock: 2026-04-28 11:38:35 CEST
Plan: Pro (expanded craft tokens; source: PubMed)
Source: PubMed
Total Abstracts/Papers: 1333
Downloaded Abstracts/Papers: 1333
Included original and non-original Abstracts/Papers (all): 540
Included original Abstracts/Papers (Vote counting by direction of effect): 502
Reference Index (links used in paper): 173
Total participants (topic deduplicated ΣN): 782518
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