• Shao-Wei Chen, Yu-Sheng Lin, Victor Chien-Chia Wu, Ming-Shyan Lin, An-Hsun Chou, Pao-Hsien Chu, and Tien-Hsing Chen.
• Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan; Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan.
• J. Thorac. Cardiovasc. Surg. 2020 May 1; 159 (5): 1694-1703.e3.

ObjectiveThe 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.MethodsA 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.ResultsA 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).Conclusionsβ-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.Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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