The incidence and mortality of acute thoracic aortic dissection: results from a whole nation study
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- 22 June 2016
- journal article
- Published by Oxford University Press (OUP) in European Journal of Cardio-Thoracic Surgery
- Vol. 50 (6), 1111-1117
- https://doi.org/10.1093/ejcts/ezw235
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.Keywords
Funding Information
- Landspitali University Hospital Scientific Fund
- University of Iceland Research Fund
This publication has 21 references indexed in Scilit:
- Risk Profiles for Aortic Dissection and Ruptured or Surgically Treated Aneurysms: A Prospective Cohort StudyJournal of the American Heart Association, 2015
- Trends in Aortic Dissection Hospitalizations, Interventions, and Outcomes Among Medicare Beneficiaries in the United States, 2000–2011Circulation: Cardiovascular Quality and Outcomes, 2014
- Population-Based Study of Incidence and Outcome of Acute Aortic Dissection and Premorbid Risk Factor Control 10-Year Results From the Oxford Vascular StudyCell Metabolism, 2013
- 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic DiseaseCirculation, 2010
- Acute aortic dissectionThe Lancet, 2008
- Thoracic Aortic Aneurysm and DissectionCirculation, 2006
- Late outcome of patients with aortic dissection: study of a national databaseEuropean Journal of Cardio-Thoracic Surgery, 2004
- Acute Aortic Dissection: Population-Based Incidence Compared With Degenerative Aortic Aneurysm RuptureMayo Clinic Proceedings, 2004
- Epidemiology and Clinicopathology of Aortic DissectionChest, 2000
- Aortic dissections and dissecting aneurysmsThe American Journal of Cardiology, 1972