Presentation, Diagnosis, and Outcomes of Acute Aortic Dissection 17-Year Trends From the International Registry of Acute Aortic Dissection
Presentation, Diagnosis, and Outcomes of Acute Aortic Dissection 17-Year Trends From the International Registry of Acute Aortic Dissection
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DOI：
10.1016/j.jacc.2015.05.029
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发表时间：
2015-07-28
影响因子：
24
通讯作者：
O'Gara, Patrick
中科院分区：
文献类型：
--
作者：
Pape, Linda A.;Awais, Mazen;O'Gara, Patrick
急性主动脉夹层（AAS）的诊断、治疗和预后正在发生变化。回顾性研究本研究从国际急性主动脉夹层登记处（IRAD）调查了17年来AAD的表现、诊断和医院预后的趋势。方法分析了1995年12月26日至2013年2月6日期间在28个IRAD中心登记的4,428例患者的数据。根据入组日期和AAD类型将患者分为6个相等的组：A（n = 2，952）或B（n = 1，476）。结果A型和B型AAD的严重或最严重疼痛的主诉（分别为93%和94%）没有变化，胸痛的发生率（分别为83%和71%）也没有变化。使用计算机断层扫描（CT）诊断A型从46%增加到73%（p < 0.001）。A型糖尿病的手术治疗率从79%上升到90%（p < 0.001）。B型的血管内治疗从7%增加到31%（p < 0.001）。A型患者住院死亡率显著降低（31%至22%; p < 0.001），手术死亡率显著降低（25%至18%; p = 0.003）。B型患者的住院死亡率（从12%到14%）无显著趋势。增加了A型患者胸部CT的使用。两组中更多的患者接受了介入治疗：A型手术和B型血管内治疗。A型患者的总体住院死亡率显著降低，但B型患者的总体住院死亡率未显著降低。(C)2015年美国心脏病学院基金会。
BACKGROUND Diagnosis, treatment, and outcomes of acute aortic dissection (AAS) are changing.OBJECTIVES This study examined 17-year trends in the presentation, diagnosis, and hospital outcomes of AAD from the International Registry of Acute Aortic Dissection (IRAD).METHODS Data from 4,428 patients enrolled at 28 IRAD centers between December 26, 1995, and February 6, 2013, were analyzed. Patients were divided according to enrollment date into 6 equal groups and by AAD type: A (n = 2,952) or B (n = 1,476).RESULTS There was no change in the presenting complaints of severe or worst-ever pain for type A and type B AAD (93% and 94%, respectively), nor in the incidence of chest pain (83% and 71%, respectively). Use of computed tomography (CT) for diagnosis of type A increased from 46% to 73% (p < 0.001). Surgical management for type A increased from 79% to 90% (p < 0.001). Endovascular management of type B increased from 7% to 31% (p < 0.001). Type A in-hospital mortality decreased significantly (31% to 22%; p < 0.001), as surgical mortality (25% to 18%; p = 0.003). There was no significant trend in in-hospital mortality in type B (from 12% to 14%).CONCLUSIONS Presenting symptoms and physical findings of AAD have not changed significantly. Use of chest CT increased for type A. More patients in both groups were managed with interventional procedures: surgery in type A and endovascular therapy in type B. A significant decrease in overall in-hospital mortality was seen for type A but not for type B. (C) 2015 by the American College of Cardiology Foundation.