The incidence and mortality of acute thoracic aortic dissection: results from a whole nation study

• Published in: European journal of cardio-thoracic surgery Vol. 50; no. 6; pp. 1111 - 1117
• Main Authors: Melvinsdottir, Inga H, Lund, Sigrun H, Agnarsson, Bjarni A, Sigvaldason, Kristinn, Gudbjartsson, Tomas, Geirsson, Arnar
• Format: Journal Article
• Language: English
• Published: Germany 01.12.2016
• Subjects: Age Factors; Aged; Aneurysm, Dissecting - epidemiology; Aneurysm, Dissecting - mortality; Aneurysm, Dissecting - surgery; Aortic Aneurysm, Thoracic - epidemiology; Aortic Aneurysm, Thoracic - mortality; Aortic Aneurysm, Thoracic - surgery; Female; Humans; Incidence; Ireland - epidemiology; Kaplan-Meier Estimate; Male; Proportional Hazards Models; Retrospective Studies; Sex Factors; Survival Analysis; Aortic dissection; Population studies; Aortic surgery; Epidemiology
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezw235

Acute thoracic aortic dissection (ATAD) is a devastating condition associated with a high mortality rate. Recent reports suggest that its incidence is rising. Utilizing nationwide data comprising the whole Icelandic population, we aimed to determine the incidence, mortality rate and time-dependent mortality risk of ATAD. Data were retrospectively collected using centralized hospital discharge registries, autopsy records and Cause of Death Registry in Iceland from 1992 to 2013. Age- and gender-adjusted incidence of ATAD was 2.53/100 000/year, and no significant change in incidence was observed during the study period. The mean age was 66.9 ± 13.6 years and 66.0% (101/153) were Stanford type A. Of the whole group, 17.6% (27/153) died prior to hospital arrival, whereas the risk of death for patients who arrived alive to a hospital was 21.4% (27/126) within 24 h and 45.2% (57/126) at 30 days. During the course of the study, patients with type A dissection were more likely to undergo an operation and the management of type B dissection changed from open to endovascular repair. The 30-day mortality rate declined every year and the 5-year survival rate improved in the last third of the study. The incidence of ATAD was 2.53/100 000/year and remained constant throughout the study, contradicting recent perceptions of a rising incidence. ATAD, type A in particular, remains a highly lethal condition: Over half of all patients die within 30 days of the index event. A reduced 30-day mortality rate and an increased long-term survival rate indicate improved overall outcomes in patients with this complex condition.