Inga H Melvinsdottir1, Sigrun H Lund2, Bjarni A Agnarsson2,3, Kristinn Sigvaldason4, Tomas Gudbjartsson1,2, Arnar Geirsson5,6,7. 1. Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland. 2. Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 3. Department of Pathology, Landspitali University Hospital, Reykjavik, Iceland. 4. Department of Anesthesiology, Landspitali University Hospital, Reykjavik, Iceland. 5. Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland arnarge@landspitali.is. 6. Section of Cardiac Surgery, Yale University School of Medicine, New Haven, CT, USA. 7. Department of Surgery, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.
Abstract
OBJECTIVES: Acute thoracic aortic dissection (ATAD) is a devastating condition associated with a high mortality rate. Recent reports suggest that its incidence is rising. Utilizing nationwide data comprising the whole Icelandic population, we aimed to determine the incidence, mortality rate and time-dependent mortality risk of ATAD. METHODS: Data were retrospectively collected using centralized hospital discharge registries, autopsy records and Cause of Death Registry in Iceland from 1992 to 2013. RESULTS: Age- and gender-adjusted incidence of ATAD was 2.53/100 000/year, and no significant change in incidence was observed during the study period. The mean age was 66.9 ± 13.6 years and 66.0% (101/153) were Stanford type A. Of the whole group, 17.6% (27/153) died prior to hospital arrival, whereas the risk of death for patients who arrived alive to a hospital was 21.4% (27/126) within 24 h and 45.2% (57/126) at 30 days. During the course of the study, patients with type A dissection were more likely to undergo an operation and the management of type B dissection changed from open to endovascular repair. The 30-day mortality rate declined every year and the 5-year survival rate improved in the last third of the study. CONCLUSIONS: The incidence of ATAD was 2.53/100 000/year and remained constant throughout the study, contradicting recent perceptions of a rising incidence. ATAD, type A in particular, remains a highly lethal condition: Over half of all patients die within 30 days of the index event. A reduced 30-day mortality rate and an increased long-term survival rate indicate improved overall outcomes in patients with this complex condition.
OBJECTIVES: Acute thoracic aortic dissection (ATAD) is a devastating condition associated with a high mortality rate. Recent reports suggest that its incidence is rising. Utilizing nationwide data comprising the whole Icelandic population, we aimed to determine the incidence, mortality rate and time-dependent mortality risk of ATAD. METHODS: Data were retrospectively collected using centralized hospital discharge registries, autopsy records and Cause of Death Registry in Iceland from 1992 to 2013. RESULTS: Age- and gender-adjusted incidence of ATAD was 2.53/100 000/year, and no significant change in incidence was observed during the study period. The mean age was 66.9 ± 13.6 years and 66.0% (101/153) were Stanford type A. Of the whole group, 17.6% (27/153) died prior to hospital arrival, whereas the risk of death for patients who arrived alive to a hospital was 21.4% (27/126) within 24 h and 45.2% (57/126) at 30 days. During the course of the study, patients with type A dissection were more likely to undergo an operation and the management of type B dissection changed from open to endovascular repair. The 30-day mortality rate declined every year and the 5-year survival rate improved in the last third of the study. CONCLUSIONS: The incidence of ATAD was 2.53/100 000/year and remained constant throughout the study, contradicting recent perceptions of a rising incidence. ATAD, type A in particular, remains a highly lethal condition: Over half of all patients die within 30 days of the index event. A reduced 30-day mortality rate and an increased long-term survival rate indicate improved overall outcomes in patients with this complex condition.
Authors: Stefanie S Portelli; Elizabeth N Robertson; Cassandra Malecki; Kiersten A Liddy; Brett D Hambly; Richmond W Jeremy Journal: Biophys Rev Date: 2018-09-28
Authors: Anne S Chin; Martin J Willemink; Aya Kino; Virginia Hinostroza; Anna M Sailer; Michael P Fischbein; R Scott Mitchell; Gerald J Berry; D Craig Miller; Dominik Fleischmann Journal: J Am Coll Cardiol Date: 2018-06-19 Impact factor: 24.094