TY - JOUR
T1 - Early Mortality in Type A Acute Aortic Dissection
T2 - Insights from the International Registry of Acute Aortic Dissection
AU - Harris, Kevin M.
AU - Nienaber, Christoph A.
AU - Peterson, Mark D.
AU - Woznicki, Elise M.
AU - Braverman, Alan C.
AU - Trimarchi, Santi
AU - Myrmel, Truls
AU - Pyeritz, Reed
AU - Hutchison, Stuart
AU - Strauss, Craig
AU - Ehrlich, Marek P.
AU - Gleason, Thomas G.
AU - Korach, Amit
AU - Montgomery, Daniel G.
AU - Isselbacher, Eric M.
AU - Eagle, Kim A.
N1 - Funding Information:
supported by W.L. Gore & Associates, participating International Registry of Acute Aortic Dissection (IRAD) aortic centers of excellence, Medtronic, the Varbedian Aortic Research Fund, the Hewlett Foundation, the Mardigian Foundation, the University of Michigan Faculty Group Practice, Terumo, and Ann and Bob Aikens.
Publisher Copyright:
© 2022 American Medical Association. All rights reserved.
PY - 2022/10
Y1 - 2022/10
N2 - Importance: Early data revealed a mortality rate of 1% to 2% per hour for type A acute aortic dissection (TAAAD) during the initial 48 hours. Despite advances in diagnostic testing and treatment, this mortality rate continues to be cited because of a lack of contemporary data characterizing early mortality and the effect of timely surgery. Objective: To examine early mortality rates for patients with TAAAD in the contemporary era. Design, Setting, and Participants: This cohort study examined data for patients with TAAAD in the International Registry of Acute Aortic Dissection between 1996 and 2018. Patients were grouped according to the mode of their intended treatment, surgical or medical. Exposure: Surgical treatment. Main Outcomes and Measures: Mortality was assessed in the initial 48 hours after hospital arrival using Kaplan-Meier curves. In-hospital complications were also evaluated. Results: A total of 5611 patients with TAAAD were identified based on intended treatment: 5131 (91.4%) in the surgical group (3442 [67.1%] male; mean [SD] age, 60.4 [14.1] years) and 480 (8.6%) in the medical group (480 [52.5%] male; mean [SD] age, 70.9 [14.7] years). Reasons for medical management included advanced age (n = 141), comorbidities (n = 281), and patient preference (n = 81). Over the first 48 hours, the mortality for all patients in the study was 5.8%. Among patients who were medically managed, mortality was 0.5% per hour (23.7% at 48 hours). For those whose intended treatment was surgical, 48-hour mortality was 4.4%. In the surgical group, 51 patients (1%) died before the operation. Conclusions and Relevance: In this study, the overall mortality rate for TAAAD was 5.8% at 48 hours. For patients in the medical group, TAAAD had a mortality rate of 0.5% per hour (23.7% at 48 hours). However, among those in the surgical group, 48-hour mortality decreased to 4.4%.
AB - Importance: Early data revealed a mortality rate of 1% to 2% per hour for type A acute aortic dissection (TAAAD) during the initial 48 hours. Despite advances in diagnostic testing and treatment, this mortality rate continues to be cited because of a lack of contemporary data characterizing early mortality and the effect of timely surgery. Objective: To examine early mortality rates for patients with TAAAD in the contemporary era. Design, Setting, and Participants: This cohort study examined data for patients with TAAAD in the International Registry of Acute Aortic Dissection between 1996 and 2018. Patients were grouped according to the mode of their intended treatment, surgical or medical. Exposure: Surgical treatment. Main Outcomes and Measures: Mortality was assessed in the initial 48 hours after hospital arrival using Kaplan-Meier curves. In-hospital complications were also evaluated. Results: A total of 5611 patients with TAAAD were identified based on intended treatment: 5131 (91.4%) in the surgical group (3442 [67.1%] male; mean [SD] age, 60.4 [14.1] years) and 480 (8.6%) in the medical group (480 [52.5%] male; mean [SD] age, 70.9 [14.7] years). Reasons for medical management included advanced age (n = 141), comorbidities (n = 281), and patient preference (n = 81). Over the first 48 hours, the mortality for all patients in the study was 5.8%. Among patients who were medically managed, mortality was 0.5% per hour (23.7% at 48 hours). For those whose intended treatment was surgical, 48-hour mortality was 4.4%. In the surgical group, 51 patients (1%) died before the operation. Conclusions and Relevance: In this study, the overall mortality rate for TAAAD was 5.8% at 48 hours. For patients in the medical group, TAAAD had a mortality rate of 0.5% per hour (23.7% at 48 hours). However, among those in the surgical group, 48-hour mortality decreased to 4.4%.
UR - http://www.scopus.com/inward/record.url?scp=85137448262&partnerID=8YFLogxK
U2 - 10.1001/jamacardio.2022.2718
DO - 10.1001/jamacardio.2022.2718
M3 - Article
C2 - 36001309
AN - SCOPUS:85137448262
SN - 2380-6583
VL - 7
SP - 1009
EP - 1015
JO - JAMA Cardiology
JF - JAMA Cardiology
IS - 10
ER -