Mortality after non-surgically treated acute type A aortic dissection is higher than previously reported
(2024) In European Journal of Cardio-Thoracic Surgery 65(2).- Abstract
OBJECTIVES: It has been commonly accepted that untreated acute type A aortic dissection (ATAAD) results in an hourly mortality rate of 1–2% during the 1st 24 h after symptom onset. The data to support this statement rely solely on patients who have been denied surgical treatment after reaching surgical centres. The objective was to perform a total review of non-surgically treated (NST) ATAAD and provide contemporary mortality data. METHODS: This was a regional, retrospective, observational study. All patients receiving one of the following diagnoses: International Classification of Diseases (ICD)-9 4410, 4411, 4415, 4416 or ICD-10 I710, I711, I715, I718 in an area of 1.9 million inhabitants in Southern Sweden during a period of 23 years... (More)
OBJECTIVES: It has been commonly accepted that untreated acute type A aortic dissection (ATAAD) results in an hourly mortality rate of 1–2% during the 1st 24 h after symptom onset. The data to support this statement rely solely on patients who have been denied surgical treatment after reaching surgical centres. The objective was to perform a total review of non-surgically treated (NST) ATAAD and provide contemporary mortality data. METHODS: This was a regional, retrospective, observational study. All patients receiving one of the following diagnoses: International Classification of Diseases (ICD)-9 4410, 4411, 4415, 4416 or ICD-10 I710, I711, I715, I718 in an area of 1.9 million inhabitants in Southern Sweden during a period of 23 years (January 1998 to November 2021) were retrospectively screened. The search was conducted using all available medical registries so that every patient diagnosed with ATAAD in our region was identified. The charts and imaging of each screened patient were subsequently reviewed to confirm or discard the diagnosis of ATAAD. RESULTS: Screening identified 2325 patients, of whom 184 NST ATAAD patients were included. The mortality of NST ATAAD was 47.3 ± 4.4%, 55.0 ± 4.4%, 76.7 ± 3.7% and 83.9 ± 4.3% at 24 h, 48 h, 14 days and 1 year, respectively. The hourly mortality rate during the 1st 24 h after symptom onset was 2.6%. CONCLUSIONS: This study observed higher mortality than has previously been reported. It emphasizes the need for timely diagnosis, swift management and emergent surgical treatment for patients suffering an acute type A aortic dissection.
(Less)
- author
- Teurneau-Hermansson, Karl LU ; Ede, Jacob LU ; Larsson, Mårten LU ; Linton, Gustaf LU ; von Rosen, David ; Sjogren, Johan LU ; Wierup, Per LU ; Nozohoor, Shahab LU and Zindovic, Igor LU
- organization
-
- Thoracic Surgery
- Neurological injury in acute type A aortic dissection (research group)
- Bleeding disorders and acute typ-A dissection (research group)
- Minimal invasive cardiac surgery in valvular heart disease (research group)
- Less invasive cardiac surgery (research group)
- Heparin bindning protein in cardiothoracic surgery (research group)
- publishing date
- 2024-02
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Aortic dissection, Mortality, Type A aortic dissection
- in
- European Journal of Cardio-Thoracic Surgery
- volume
- 65
- issue
- 2
- article number
- ezae039
- publisher
- Oxford University Press
- external identifiers
-
- pmid:38310329
- scopus:85185269762
- ISSN
- 1010-7940
- DOI
- 10.1093/ejcts/ezae039
- language
- English
- LU publication?
- yes
- id
- 5bc6c730-9ece-4fc0-ab05-74dadb285f79
- date added to LUP
- 2024-03-27 13:20:23
- date last changed
- 2024-09-12 06:47:30
@article{5bc6c730-9ece-4fc0-ab05-74dadb285f79, abstract = {{<p>OBJECTIVES: It has been commonly accepted that untreated acute type A aortic dissection (ATAAD) results in an hourly mortality rate of 1–2% during the 1st 24 h after symptom onset. The data to support this statement rely solely on patients who have been denied surgical treatment after reaching surgical centres. The objective was to perform a total review of non-surgically treated (NST) ATAAD and provide contemporary mortality data. METHODS: This was a regional, retrospective, observational study. All patients receiving one of the following diagnoses: International Classification of Diseases (ICD)-9 4410, 4411, 4415, 4416 or ICD-10 I710, I711, I715, I718 in an area of 1.9 million inhabitants in Southern Sweden during a period of 23 years (January 1998 to November 2021) were retrospectively screened. The search was conducted using all available medical registries so that every patient diagnosed with ATAAD in our region was identified. The charts and imaging of each screened patient were subsequently reviewed to confirm or discard the diagnosis of ATAAD. RESULTS: Screening identified 2325 patients, of whom 184 NST ATAAD patients were included. The mortality of NST ATAAD was 47.3 ± 4.4%, 55.0 ± 4.4%, 76.7 ± 3.7% and 83.9 ± 4.3% at 24 h, 48 h, 14 days and 1 year, respectively. The hourly mortality rate during the 1st 24 h after symptom onset was 2.6%. CONCLUSIONS: This study observed higher mortality than has previously been reported. It emphasizes the need for timely diagnosis, swift management and emergent surgical treatment for patients suffering an acute type A aortic dissection.</p>}}, author = {{Teurneau-Hermansson, Karl and Ede, Jacob and Larsson, Mårten and Linton, Gustaf and von Rosen, David and Sjogren, Johan and Wierup, Per and Nozohoor, Shahab and Zindovic, Igor}}, issn = {{1010-7940}}, keywords = {{Aortic dissection; Mortality; Type A aortic dissection}}, language = {{eng}}, number = {{2}}, publisher = {{Oxford University Press}}, series = {{European Journal of Cardio-Thoracic Surgery}}, title = {{Mortality after non-surgically treated acute type A aortic dissection is higher than previously reported}}, url = {{http://dx.doi.org/10.1093/ejcts/ezae039}}, doi = {{10.1093/ejcts/ezae039}}, volume = {{65}}, year = {{2024}}, }