Association between Atherosclerotic Index of Plasma and Long-term Aorta-related Adverse Events in TEVAR-treated Type B Aortic Dissection Patients

Background Previous research identifies the atherosclerotic index of plasma (AIP) as a key marker for cardiovascular risk, but its role in predicting aorta-related adverse events (ARAEs) in type B aortic dissection (TBAD) patients post-thoracic endovascular aortic repair (TEVAR) is uncertain. This study investigates the link between AIP and ARAEs at 1-year and 5-year intervals in TBAD patients after TEVAR, suggesting a new prognostic indicator for TBAD outcomes. Methods This retrospective cohort study involved 1,335 TBAD patients who underwent TEVAR, with clinical data extracted from electronic records. AIP was calculated as log (triglycerides/high-density lipoprotein cholesterol [TG/HDL-C]), and patients were categorized into three AIP tertiles. The primary endpoints were ARAEs at 1 and 5 years post-TEVAR. Cox regression identified variables linked to endpoints and assessed AIP's independent impact on ARAEs. Kaplan-Meier curves and log-rank tests compared ARAE incidence across groups. RCS models examined the AIP-ARAEs dose-response relationship, while subgroup analyses confirmed the association's stability. Time-dependent ROC curves evaluated AIP's predictive power for ARAEs over five years. Results Kaplan-Meier analysis showed higher incidence of ARAEs in AIP High group compared to Low group (1 year: 19.51% vs. 5.81%; 5 years: 24.39% vs. 10.32%; both P < 0.05). Cox analysis showed AIP High group had higher ARAE risk (1-year HR = 4.63, 95% CI: 2.57–8.34; 5-year HR = 2.59, 95% CI: 1.78–3.78; all P < 0.001). Furthermore, RCS analysis indicated a continuous positive linear relationship between AIP and ARAEs. Time-dependent ROC showed the area under the curve (AUC) surpassing 80% throughout the five-year duration. Subgroup analysis revealed higher AIP-related ARAEs risk in subacute surgery patients (1 year: HR = 6.78; 5 years: HR = 2.96) and lower risk in chronic surgery patients (1 year: HR = 0.02; 5 years: HR = 0.24). In the 5-year subgroup analysis, patients without chronic kidney disease (CKD) had a notably higher risk of AIP compared to those with CKD (HR = 2.09 vs. HR = 0.41) (P-interaction = 0.082). Conclusion AIP serves as an independent influencing factor for both the short term (1 year) and the long term (5 years) following TEVAR in patients with TBAD, demonstrating a linear relationship between the two timeframes. These findings highlight the significance of AIP as a crucial risk biomarker, providing a simple yet effective method for identifying the risk of ARAEs in this patient population.