In patients with acute aortic dissection, in-hospital mortality for Type A and Type B dissection has decreased over time, with an increase in five-year survival, according to results of the IRAD study presented March 18 at ACC.19 in New Orleans, LA.

Kim A. Eagle, MD, MACC, et al., looked at 9,000 patients enrolled in the International Registry of Acute Aortic Dissection (IRAD) at 55 centers in 13 countries from 1996-2019. Investigators compared diagnosis, treatment, in-hospital and five-year mortality.

Results showed that hypertension, smoking and atherosclerosis are the most common risk factors for aortic dissection. CT scan remains the most common diagnostic imaging test. Of note, surgical management has increased for Type A dissection from 85 percent to 88.6 percent. For Type A dissection, overall in-hospital mortality has fallen from 26.2 percent to 16.3 percent, and five-year survival increased from 81.9 percent to 88.5 percent.

For Type B management, results show that endovascular therapy has increased from 19.5 percent to 31.2 percent, and surgery management has dropped from 15 percent to 6.1 percent. Overall in-hospital mortality for Type B dissection has decreased from 10.2 percent to 7.4 percent, and five-year survival increased from 74 percent to 83.7 percent.

The investigators conclude that they expect endovascular, surgical and medical therapies to evolve and improve patient outcomes. Better diagnostic tools are needed to identify patients at risk and speed treatment in acute dissection.

"These important data from IRAD nicely show how much progress has been made in the care of patients with aortic dissection," says Deepak L. Bhatt, MD, MPH, FACC, senior associate editor of ACC.org.

Keywords: ACC19, ACC Annual Scientific Session, Aortic Aneurysm, Aneurysm, Dissecting, Aneurysm

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