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Trends in Acute Aortic Dissection Over 17 Years
Study Questions:
What are the trends in patient presentation, utilization of advanced imaging, management, and hospital outcomes in acute aortic dissection (AAD) over 17 prospective years?
Methods:
Twenty-eight referral centers throughout North America, Europe, and Asia participated in this study. Data were collected on an unselected population of all 4,428 IRAD (International Registry of Acute Aortic Dissection) patients presenting with AAD from January 1996 through February 2013. Patients were divided according to enrollment date into six equal groups, and by AAD type: A (n = 2,952) or B (n = 1,476). Linear-by-linear association was used to evaluate linear trends across time groups. Differences among patient groups stratified by time periods for continuous variables were determined utilizing one-way analysis of variance (ANOVA).
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) in 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 well 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:
The authors concluded that presenting symptoms and physical findings of AAD have not changed significantly over 17 years, and a significant decrease in overall in-hospital mortality was seen for type A, but not for type B AAD.
Perspective:
This large registry reports that the most notable changes over time in the presentation, diagnosis, treatment, and outcomes of patients with AAD include an increase in the frequency of use of CT as the primary imaging modality, more frequent treatment of type A patients with surgery, and increasing use of endovascular therapies for the management of patients with complicated type B. Type A patients demonstrated improved mortality over time, both overall and among surgical patients alone. Long-term temporal trends from IRAD are an important source of information that may be used to optimize diagnosis and management of AAD.
Keywords: Aneurysm, Dissecting, Aortic Aneurysm, Cardiac Surgical Procedures, Chest Pain, Diagnostic Imaging, Endovascular Procedures, Hospital Mortality, Tomography, Tomography, Emission-Computed
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