The International Registry of Acute Aortic Dissection (IRAD) - New insights into an old disease
The International Registry of Acute Aortic Dissection (IRAD) - New insights into an old disease
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DOI：
10.1001/jama.283.7.897
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发表时间：
2000-02-16
影响因子：
120.7
通讯作者：
Eagle, KA
中科院分区：
文献类型：
--
作者：
Hagan, PG;Nienaber, CA;Eagle, KA
急性主动脉夹层是一种危及生命的急症，发病率和死亡率都很高。数据是有限的，关于最近的成像和治疗进展对病人的护理和结果在this setting.Objective的影响，以评估的介绍，管理和急性主动脉夹层的结局。设计病例系列与1996年1月和1998年12月之间招募的患者。研究对象：急性主动脉夹层国际登记研究，由12个国际转诊中心组成，共464例患者，其中12例为急性主动脉夹层患者，12例为急性主动脉夹层患者（平均年龄63岁; 65.3%的男性），其中62.3%的人有A型夹层。主要结果测量提供病史，物理发现，管理和死亡率，根据病史和医生对医院记录的回顾进行评估。结果虽然突然发作的剧烈尖锐疼痛是最常见的主诉，但临床表现多样。仅分别在31.6%和15.1%的患者中观察到典型的体格检查结果，如主动脉瓣返流和脉搏缺损，并且初始胸片和心电图通常没有帮助（分别在12.4%和31.3%的患者中未观察到异常）。计算机断层扫描是61.1%患者使用的初始成像方式，总体住院死亡率为27.4%，手术治疗的A型夹层患者的死亡率为26%;在未接受手术的患者中（通常是因为高龄和合并症），死亡率为58%。经药物治疗的B型夹层患者的死亡率为10.7%。B型主动脉夹层的手术率为20%，死亡率为31.4%。结论急性主动脉夹层临床表现多样，常缺乏典型表现。高度的临床怀疑指数是必要的。尽管最近取得了进展，但住院死亡率仍然很高。我们的数据支持需要继续改善急性主动脉夹层的预防、诊断和治疗。
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.