Acute aortic dissection: Population-based incidence compared with degenerative aortic aneurysm rupture
Acute aortic dissection: Population-based incidence compared with degenerative aortic aneurysm rupture
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DOI：
10.4065/79.2.176
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发表时间：
2004-02-01
影响因子：
8.9
通讯作者：
Melton, LJ
中科院分区：
文献类型：
--
作者：
Clouse, WD;Hallett, JW;Melton, LJ
目的：为了确定急性主动脉夹层（AAD）是否仍然是最常见的主动脉灾难，一般认为，并检测任何改善的结果与以前报道的人口为基础的data.Patients和方法：我们确定了发病率，手术干预率，和长期生存率的奥姆斯特德县，明尼苏达州，居民与AAD的临床诊断最初在1980年和1994年之间。还描述了退行性胸主动脉瘤（TAA）破裂的发生率。我们将这些结果与其他基于人群的AAD、退行性TAA和腹主动脉瘤（AAA）破裂研究进行了比较。结果：在15年期间，我们确定了177例胸主动脉疾病患者。我们关注39例AAD患者（占整个队列的22%）和28例TAA破裂患者（16%）。经年龄和性别校正的AAD年发生率为3.5/100，000人（95%置信区间，2.4-4.6），TAA破裂为3.5/100，000人（95%置信区间，2.2-4.9）。33例夹层（85%）涉及升主动脉，而6例（15%）仅涉及降主动脉。19例患者（49%）因AAD接受了22次手术，30天病死率为9%。在所有39例AAD患者中，中位生存期仅为3天。与1951年至1980年该社区仅5%的患者相比，AAD患者的总体5年生存率提高至32%。结论：在其他研究中，TAA破裂和AAA破裂的年发生率估计分别约为3/100，000和9/100，000。该研究表明，AAD和退行性TAA破裂的发生频率相似，但低于AAA破裂。虽然及时识别和管理仍然存在问题，这些新的数据表明，最近的诊断和手术的进步正在提高AAD的长期生存率。
Objectives: To ascertain whether acute aortic dissection (AAD) remains the most common aortic catastrophe, as generally believed, and to detect any improvement in outcomes compared with previously reported population-based data.Patients and Methods: We determined the incidence, operative intervention rate, and long-term survival rate of Olmsted County, Minnesota, residents with a clinical diagnosis of AAD initially made between 1980 and 1994. The incidence of degenerative thoracic aortic aneurysm (TAA) rupture was also delineated. We compared these results with other population-based studies of AAD, degenerative TAA, and abdominal aortic aneurysm (AAA) rupture.Results: During a 15-year period, we identified 177 patients with thoracic aortic disease. We focused on 39 patients with AAD (22% of the entire cohort) and 28 with TAA rupture (16%). The annual age- and sex-adjusted incidences were 3.5 per 100,000 persons (95% confidence interval, 2.4-4.6) for AAD and 3.5 per 100,000 persons (95% confidence interval, 2.2-4.9) for TAA rupture. Thirty-three dissections (85%) involved the ascending aorta, whereas 6 (15%) involved only the descending aorta. Nineteen patients (49%) underwent 22 operations for AAD, with a 30-day case fatality rate of 9%. Among all 39 patients with AAD, median survival was only 3 days. Overall 5-year survival for those with AAD improved to 32% compared with only 5% in this community between 1951 and 1980.Conclusions: In other studies, the annual incidences of TAA rupture and AAA rupture are estimated at approximately 3 and 9 per 100,000 persons, respectively. This study indicates that AAD and ruptured degenerative TAA occur with similar frequency but less commonly than ruptured AAA. Although timely recognition and management remain problematic, these new data suggest that recent diagnostic and operative advances are improving long-term survival in AAD.