Tetsuo Yamaguchi1, Michikazu Nakai2, Takao Yano3, Masakazu Matsuyama4, Hideaki Yoshino5, Yoshihiro Miyamoto2, Yoko Sumita2, Hitoshi Matsuda6, Yousuke Inoue6, Yutaka Okita7, Kenji Minatoya8, Yuichi Ueda9, Hitoshi Ogino10. 1. Department of Cardiovascular Center, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo 105-8470, Japan. 2. Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, 6-1, Kishibe-shinmachi, Suita city, Osaka 565-8565, Japan. 3. Department of Critical Care and Emergency Medicine, Miyazaki Prefectural Nobeoka Hospital, 2-1-10, Shin-koji, Nobeoka City, Miyazaki 882-0835, JAPAN. 4. Department of Cardiovascular Surgery, Miyazaki Prefectural Nobeoka hospital, 2-1-10, Shin-koji, Nobeoka city, Miyazaki 882-0835, Japan. 5. Department of Cardiology, Kyorin University Graduate School of Medicine, 20-2, Shinkawa, Mitaka city, Tokyo 181-8611, Japan. 6. Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1, Kishibe-shinmachi, Suita city, Osaka 565-8565, Japan. 7. Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunokicho, chuo-ku, Kobe city, Hyogo 650-0017, Japan. 8. Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, 54, Shogoin-Kawaramachi, Sakyo-ku, Kyoto 606-8507, Japan. 9. Department of Cardiology, Nara Prefecture General Medical Center, 2-897-5, Shichijo-Nishimachi, Nara 630-8581, Japan. 10. Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
Abstract
AIMS: The population-based incidence and outcomes of acute aortic dissection (AAD) are still unknown because some patients are already dead on arrival, and the accurate diagnosis of AAD is difficult due to the low autopsy rate. We performed a population-based review of all patients with AAD in a well-defined geographical area in Japan between 2016 and 2018. METHODS AND RESULTS: Data of all patients with AAD at Miyazaki Prefectural Nobeoka Hospital (MPNH), which performs medical care for 120 000 residents, were collected retrospectively. The emergency medical service is dedicated to the transfer of all patients in this area to the MPNH. For all patients who were dead on arrival, the diagnosis of AAD was made by autopsy imaging (AI) using computed tomography. The age-adjusted incidence and mortality per 100 000 population were calculated using the Japanese population distribution model in 2015. The total incidence of AAD was 79 (type A: 64.5%, n = 51). Of those, 60.8% (31/51) of patients with type A and 21.4% (6/28) with type B were dead on arrival and diagnosed by AI. The 30-day mortality rates were 74.5% (38/51) in type A and 25.0% (7/28) in type B. The age-adjusted incidence and mortality of AAD per 100 000 inhabitants were 17.6 (type A: 11.3, type B: 6.2) and 9.9 (type A: 8.4, type B: 1.5), respectively. CONCLUSIONS: The population-based survey of AAD showed that the age-adjusted incidence of AAD was two-fold higher than in previous reports, and the actual mortality rates were markedly higher due to the high incidence of dead-on-arrival. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: The population-based incidence and outcomes of acute aortic dissection (AAD) are still unknown because some patients are already dead on arrival, and the accurate diagnosis of AAD is difficult due to the low autopsy rate. We performed a population-based review of all patients with AAD in a well-defined geographical area in Japan between 2016 and 2018. METHODS AND RESULTS: Data of all patients with AAD at Miyazaki Prefectural Nobeoka Hospital (MPNH), which performs medical care for 120 000 residents, were collected retrospectively. The emergency medical service is dedicated to the transfer of all patients in this area to the MPNH. For all patients who were dead on arrival, the diagnosis of AAD was made by autopsy imaging (AI) using computed tomography. The age-adjusted incidence and mortality per 100 000 population were calculated using the Japanese population distribution model in 2015. The total incidence of AAD was 79 (type A: 64.5%, n = 51). Of those, 60.8% (31/51) of patients with type A and 21.4% (6/28) with type B were dead on arrival and diagnosed by AI. The 30-day mortality rates were 74.5% (38/51) in type A and 25.0% (7/28) in type B. The age-adjusted incidence and mortality of AAD per 100 000 inhabitants were 17.6 (type A: 11.3, type B: 6.2) and 9.9 (type A: 8.4, type B: 1.5), respectively. CONCLUSIONS: The population-based survey of AAD showed that the age-adjusted incidence of AAD was two-fold higher than in previous reports, and the actual mortality rates were markedly higher due to the high incidence of dead-on-arrival. Published on behalf of the European Society of Cardiology. All rights reserved.