Presentation, Diagnosis, and Outcomes of Acute Aortic Dissection: 17-Year Trends From the International Registry of Acute Aortic Dissection
Linda A Pape, Mazen Awais, Elise M Woznicki, Toru Suzuki, Santi Trimarchi, Arturo Evangelista, Truls Myrmel, Magnus Larsen, Kevin M Harris, Kevin Greason, Marco Di Eusanio, Eduardo Bossone, Daniel G Montgomery, Kim A Eagle, Christoph A Nienaber, Eric M Isselbacher, Patrick O'Gara, Linda A Pape, Mazen Awais, Elise M Woznicki, Toru Suzuki, Santi Trimarchi, Arturo Evangelista, Truls Myrmel, Magnus Larsen, Kevin M Harris, Kevin Greason, Marco Di Eusanio, Eduardo Bossone, Daniel G Montgomery, Kim A Eagle, Christoph A Nienaber, Eric M Isselbacher, Patrick O'Gara
Abstract
Background: Diagnosis, treatment, and outcomes of acute aortic dissection (AAS) are changing.
Objectives: This study examined 17-year trends in the presentation, diagnosis, and hospital outcomes of AAD from the International Registry of Acute Aortic Dissection (IRAD).
Methods: Data from 4,428 patients enrolled at 28 IRAD centers between December 26, 1995, and February 6, 2013, were analyzed. Patients were divided according to enrollment date into 6 equal groups and by AAD type: A (n = 2,952) or B (n = 1,476).
Results: There was no change in the presenting complaints of severe or worst-ever pain for type A and type B AAD (93% and 94%, respectively), nor in the incidence of chest pain (83% and 71%, respectively). Use of computed tomography (CT) for diagnosis of type A increased from 46% to 73% (p < 0.001). Surgical management for type A increased from 79% to 90% (p < 0.001). Endovascular management of type B increased from 7% to 31% (p < 0.001). Type A in-hospital mortality decreased significantly (31% to 22%; p < 0.001), as surgical mortality (25% to 18%; p = 0.003). There was no significant trend in in-hospital mortality in type B (from 12% to 14%).
Conclusions: Presenting symptoms and physical findings of AAD have not changed significantly. Use of chest CT increased for type A. More patients in both groups were managed with interventional procedures: surgery in type A and endovascular therapy in type B. A significant decrease in overall in-hospital mortality was seen for type A but not for type B.
Keywords: acute aortic dissection; management; outcomes.
Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed