Geographic Differences in Clinical Presentation, Treatment, and Outcomes in Type A Acute Aortic Dissection (from the International Registry of Acute Aortic Dissection)
Geographic Differences in Clinical Presentation, Treatment, and Outcomes in Type A Acute Aortic Dissection (from the International Registry of Acute Aortic Dissection)
复制标题
DOI：
10.1016/j.amjcard.2008.07.049
复制
发表时间：
2008-12-01
影响因子：
2.8
通讯作者：
Bossone, Eduardo
中科院分区：
文献类型：
--
作者：
Raghupathy, Arun;Nienaber, Christoph A.;Bossone, Eduardo
尽管一些研究提供了关于几种心血管急症（如心肌梗死和卒中）全球差异的有力证据，但主动脉疾病的数据有限。目的是在大量连续患者中探索A型急性主动脉夹层（TA-AAD）的地理差异。研究了来自IRAD的TA-AAD患者（n = 615）在欧洲与北美的症状和体征、诊断、管理和结局。与欧洲人相比，北美人更可能年龄更大，表现出非典型特征，并且没有许多AAD的经典胸部X线表现。在北美队列中，心电图结果显示非特异性ST段改变的发生率较高，并有ST段抬高或新发心肌梗死的趋势（北美vs欧洲7.9% vs 4.4%; p = 0.09）。在北美和欧洲中心之间，使用影像学研究来确认AAD的诊断各不相同。北美中心平均进行了1.6项成像研究，而欧洲组为1.8项（p = 0.002）。此外，他们明显不太可能使用计算机断层扫描，而更可能使用经食管检查作为整体诊断算法的一部分。与欧洲人相比，TA-AAD发生在较小的主动脉直径，北美人的表现和诊断有很大的延迟。两组之间未观察到早期死亡率的显著差异。总之，强调了表现和初始管理的地理差异，但这并没有转化为早期死亡率的差异。(c)2008年爱思唯尔公司All rights reserved. (Am J Cardiol 2008; 102：1562 - 1566）
Although several studies have provided robust evidence about global differences for several cardiovascular emergencies, such as myocardial infarction and stroke, data were limited for aortic disease. The aim was to explore geographic variation in type A acute aortic dissection (TA-AAD) in a large group of consecutive patients. Patients (n = 615) from the IRAD with TA-AAD were studied with respect to presenting symptoms and signs, diagnosis, management, and outcomes in Europe versus North America. Compared with Europeans, North Americans were more likely to be older and present with atypical features and without many of the classic chest X-ray findings of AAD. In the North American cohort, electrocardiographic findings showed higher rates of nonspecific ST changes and a trend toward ST-elevation or new myocardial infarction (North Americans vs Europeans 7.9% vs 4.4%; p = 0.09). Use of imaging studies to confirm the diagnosis of AAD varied between North American and European centers. North American centers performed an average of 1.6 imaging studies compared with 1.8 in the European group (p = 0.002). Furthermore, they were significantly less likely to use computed tomography and significantly more likely to use transesophageal examination as part of the overall diagnostic algorithm. Compared with Europeans, TA-AAD occurred at smaller aortic diameters and there was a substantial delay to presentation and diagnosis in North Americans. No significant differences for early mortality rates were observed between the 2 groups. In conclusion, geographic differences in presentation and initial management were highlighted, but this did not translate into a difference in early mortality. (c) 2008 Elsevier Inc. All rights reserved. (Am J Cardiol 2008;102:1562-1566)