Acute Aortic Dissection in Blacks: Insights From the International Registry of Acute Aortic Dissection

Study Questions:

What is the racial heterogeneity in etiology, clinical features, diagnostic findings, treatments, and outcomes (including long-term mortality) of blacks and whites with acute aortic dissection?

Methods:

The investigators evaluated black (n = 189, 14%) or white (n = 1165, 86%) patients (mean age 62.8 ± 15.3 years; 36.4% women) enrolled in 13 US centers participating in the International Registry of Acute Aortic Dissection. They excluded patients of other racial descent. For in-hospital mortality, adjusted odds ratios and 95% confidence intervals were constructed. For long-term death, a Kaplan-Meier survival analysis was performed to compute survival estimates, hazard ratios, and 95% confidence intervals.

Results:

Type B acute aortic dissection was more frequent in the black cohort (52.4% vs. 39.3%, P = 0.001). Black patients were younger (mean age 54.6 ± 12.8 years vs. 64.2 ± 15.2 years, p < 0.001) and more likely to have a history of cocaine abuse (12% vs. 1.6%, p < 0.001), hypertension (89.7% vs. 73.9%, p < 0.001), and diabetes (13.2% vs. 6.4%, p = 0.001). Conversely, they were less likely to have bicuspid aortic valve (1.8% vs. 5.8%, p = 0.029), iatrogenic dissection (0.5% vs. 4.5%, p = 0.010), and prior aortic dissection repair (7.7% vs. 12.8%, p = 0.047). Presenting features were similar except for more abdominal pain (44.6% vs. 30.6%, p < 0.001) and left ventricular hypertrophy on echocardiogram (44.2% vs. 20.1%, p < 0.001) in blacks. Management was similar. Hypotension/shock/tamponade was less common (7.6% vs 20.1%, p < 0.001), whereas acute kidney failure was more common (41.0% vs. 21.7%, p < 0.001) in blacks. Mortality was similar in-hospital (14.3% vs. 19.1%, p = 0.110, odds ratio 0.704, 95% confidence interval 0.457-1.085) and at 3 years postdischarge, as evaluated by Kaplan-Meier survival analysis (22.0% vs. 14.3%, p = 0.224, standard error = 0.062 and 0.018).

Conclusions:

The authors concluded that there are differences in type, etiology, and presentation of blacks and whites with acute aortic dissection, but with similar mortality for these cohorts.

Perspective:

This study indicates significant variation in etiology and clinical presentation between black and white patients with acute aortic dissection, with blacks more likely to be admitted with type B dissection as compared with whites. Despite important differences in type, etiology, and clinical presentation of blacks and whites with acute aortic dissection, these data indicate more similarities than differences, especially in mortality for both type A and B acute aortic dissection in the two cohorts. Future studies are needed involving a large number of black patients with acute aortic dissection to evaluate optimal prevention and treatment strategies for reducing and improving outcomes of black patients.

Clinical Topics: Prevention, Hypertension

Keywords: Registries, Cardiology, European Continental Ancestry Group, Cardiovascular Diseases, Hypotension, African Continental Ancestry Group, Hypertension


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