{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T09:08:41Z","timestamp":1783674521622,"version":"3.55.0"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,1,20]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">The decision to perform ascending thoracic aortic aneurysm (ATAA) repair is primarily guided by diameter thresholds, but the optimal timing remains debated. We aimed to analyze ATAA outcomes in a large cohort of veterans.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">Retrospective cohort study of patients with ATAA with diameter\u22654.0\u2009cm under surveillance between 1998 and 2024. Outcomes included surgical repair, all\u2010cause mortality, and aortic events. Fine\u2013Gray competing risks regression evaluated the association of baseline diameter with all\u2010cause mortality, adjusting for age, hypertension, smoking, heart failure, and aortic valve phenotype. Results are reported as adjusted subdistribution hazard ratios (aSHRs) with 95% CIs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      We included 764 veterans (98.0% male) with median (interquartile range) age of 75.0 (9.3) years, and ATAA diameter of 4.40 (0.50) cm. Median follow\u2010up was 5.4 (6.2) years. Surgical repair occurred in 86\/764 patients (11.3%). Aortic dissection occurred in 2 patients (0.3%), both within the 4.0 to 4.5\u2009cm group. All\u2010cause mortality rates were 2.83 (2.23\u20133.59), 3.22 (2.47\u20134.21), 5.82 (3.91\u20138.67), and 24.6 (12.2\u201354.1) deaths per 100 person\u2010years for ATAA diameters 4.0 to 4.4, 4.5 to 4.9, 5.0 to 5.4, and \u22655.5\u2009cm, respectively (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001). In multivariable analysis, all\u2010cause mortality was independently associated with increasing ATAA diameter (aSHR, 1.36 per 0.5cm increase [95% CI, 1.14\u20131.63];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001) and increasing age (aSHR, 1.07 per year [95% CI, 1.05\u20131.09];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">ATAA all\u2010cause mortality increases with diameter, with a 7\u2010fold incidence increase in aneurysms \u22655.5\u2009cm. Our findings support the 5.5\u2009cm threshold for prophylactic ATAA repair and emphasize the need for selective intervention in smaller aneurysms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.044959","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T11:42:12Z","timestamp":1768390932000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Ascending Thoracic Aortic Aneurysms in a Veterans Affairs Health System: Longitudinal Outcomes and Risk Factors"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9884-2657","authenticated-orcid":false,"given":"Axel","family":"Gomez","sequence":"first","affiliation":[{"name":"University of California San Francisco and San Francisco VA Health Care System","place":["San Francisco, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Carroway","sequence":"additional","affiliation":[{"name":"University of California San Francisco and San Francisco VA Health Care System","place":["San Francisco, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally","family":"Tu","sequence":"additional","affiliation":[{"name":"University of California San Francisco and San Francisco VA Health Care System","place":["San Francisco, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8451-7469","authenticated-orcid":false,"given":"Vidur","family":"Kailash","sequence":"additional","affiliation":[{"name":"University of California San Francisco and San Francisco VA Health Care System","place":["San Francisco, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Ge","sequence":"additional","affiliation":[{"name":"University of California San Francisco and San Francisco VA Health Care System","place":["San Francisco, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3158-3144","authenticated-orcid":false,"given":"Marko","family":"Boskovski","sequence":"additional","affiliation":[{"name":"University of California San Francisco and San Francisco VA Health Care System","place":["San Francisco, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5519-6747","authenticated-orcid":false,"given":"Elaine E.","family":"Tseng","sequence":"additional","affiliation":[{"name":"University of California San Francisco and San Francisco VA Health Care System","place":["San Francisco, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehi024"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.05.029"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.031264"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.semtcvs.2021.02.029"},{"key":"e_1_3_2_6_2","unstructured":"National Center for Injury Prevention and Control . 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