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. 2015 Jul 28;66(4):350-8.
doi: 10.1016/j.jacc.2015.05.029.

Presentation, Diagnosis, and Outcomes of Acute Aortic Dissection: 17-Year Trends From the International Registry of Acute Aortic Dissection

Linda A Pape  1 , Mazen Awais  2 , Elise M Woznicki  3 , Toru Suzuki  4 , Santi Trimarchi  5 , Arturo Evangelista  6 , Truls Myrmel  7 , Magnus Larsen  7 , Kevin M Harris  8 , Kevin Greason  9 , Marco Di Eusanio  10 , Eduardo Bossone  11 , Daniel G Montgomery  3 , Kim A Eagle  3 , Christoph A Nienaber  12 , Eric M Isselbacher  13 , Patrick O'Gara  14
Affiliations
Free article

Presentation, Diagnosis, and Outcomes of Acute Aortic Dissection: 17-Year Trends From the International Registry of Acute Aortic Dissection

Linda A Pape et al. J Am Coll Cardiol. .
Free article

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.

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