THE
INTERNATIONAL REGISTRY OF ACUTE AORTIC DISSECTION (IRAD): NEW INSIGHTS INTO AN
OLD DISEASE.
Hagan
PG, et al. JAMA 2000 Feb 16;283(7):897-903.
CONTEXT:
Acute aortic dissection is a life-threatening medical emergency associated with
high rates of morbidity and mortality. Data are limited regarding the effect of
recent imaging and therapeutic advances on patient care and outcomes in this
setting.
OBJECTIVE:
To assess the presentation, management, and outcomes of acute aortic
dissection. DESIGN: Case series with patients enrolled between January 1996 and
December 1998. Data were collected at presentation and by physician review of
hospital records.
SETTING:
The International Registry of Acute Aortic Dissection, consisting of 12
international referral centers. PARTICIPANTS: A total of 464 patients (mean
age, 63 years; 65.3% male), 62.3% of whom had type A dissection.
MAIN
OUTCOME MEASURES: Presenting history, physical findings, management, and
mortality, as assessed by history and physician review of hospital records.
RESULTS:
While sudden onset of severe sharp pain was the single most common presenting
complaint, the clinical presentation was diverse. Classic physical findings
such as aortic regurgitation and pulse deficit were noted in only 31.6% and
15.1% of patients, respectively, and initial chest radiograph and
electrocardiogram were frequently not helpful (no abnormalities were noted in
12.4% and 31.3% of patients, respectively). Computed tomography was the initial
imaging modality used in 61.1%. Overall in-hospital mortality was 27.4%.
Mortality of patients with type A dissection managed surgically was 26%; among
those not receiving surgery (typically because of advanced age and
comorbidity), mortality was 58%. Mortality of patients with type B dissection
treated medically was 10.7%. Surgery was performed in 20% of patients with type
B dissection; mortality in this group was 31.4%.
CONCLUSIONS:
Acute aortic dissection presents with a wide range of manifestations, and
classic findings are often absent. A high clinical index of suspicion is
necessary. Despite recent advances, in-hospital mortality rates remain high.
Our data support the need for continued improvement in prevention, diagnosis,
and management of acute aortic dissection.