Susceptibility to acute thoracic aortic dissections in patients dying outside the hospital: an autopsy study

Abstract

Background: The objectives of this study were to identify the incidence and predictors of death from acute thoracic aortic dissections (AoDs) and to describe their associated clinical findings.

Methods: We analyzed the clinical and pathologic data from 141 consecutive autopsies of individuals with sudden death due to AoDs in Harris County, TX, from 2003 to 2010, which represented 20% (107/534) of all deaths attributed to AoDs during this period by the Texas Department of Health. Multivariate Cox regression was used to identify predictors of survival adjusting for differences in demographic and clinical characteristics.

Results: During the study period, 141 of 145 fatal victims of acute thoracic dissections underwent a full autopsy and were included in the analysis. In 84% of cases, death was caused by pericardial tamponade from ascending AoD. The frequency of deaths showed seasonal variation with peak incidence in the winter months. Compared with patients presenting to hospitals with AoD, individuals dying outside the hospital were more likely to be female, African American, younger than 50 years and to have had prior aortic disease. One third of subjects with AoD had seen a physician within 1 week of sudden death. The most consistent pathologic abnormality was marked ventricular hypertrophy (257 g/m(2) on average) out of proportion to expected values for age, gender, and body size. Hispanic patients and patients with congenital disorders, such as bicuspid aortic valve and Marfan syndrome, were significantly more likely to die of AoD at a younger age (38% vs 13%, P < .002).

Conclusions: Our findings identify differences between patients hospitalized for AoD versus those who died without being hospitalized. Previously unreported vulnerabilities to sudden death from AoD in minority populations, specifically Hispanics, were also identified that merit follow-up in prospective studies.