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Mortality after non-surgically treated acute type A aortic dissection is higher than previously reported

Teurneau-Hermansson, Karl LU orcid ; Ede, Jacob LU orcid ; Larsson, Mårten LU ; Linton, Gustaf LU ; von Rosen, David ; Sjogren, Johan LU ; Wierup, Per LU ; Nozohoor, Shahab LU and Zindovic, Igor LU (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.

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author
; ; ; ; ; ; ; and
organization
publishing date
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
2024-04-24 17:20:37
@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}},
}