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(Circulation. 2003;108:II-312.)
© 2003 American Heart Association, Inc.

Surgery for Aortic and Peripheral Vascular Disease

Clinical Profiles and Outcomes of Acute Type B Aortic Dissection in the Current Era: Lessons From the International Registry of Aortic Dissection (IRAD)

Toru Suzuki, MD; Rajendra H. Mehta, MD; Hüseyin Ince, MD; Ryozo Nagai, MD; Yasunari Sakomura, MD; Frank Weber, MD; Tetsuya Sumiyoshi, MD; Eduardo Bossone, MD; Santi Trimarchi, MD; Jeanna V. Cooper, MS; Dean E. Smith, PhD; Eric M. Isselbacher, MD; Kim A. Eagle, MD; Christoph A. Nienaber, MD

From the Division of Cardiology, University Hospital Rostock, Rostock School of Medicine, Rostock, Germany.

Correspondence to Christoph A. Nienaber, MD, FACC, Division of Cardiology, University Hospital Rostock, Rostock School of Medicine, E.-Heydemann-Str. 6, 18057 Rostock, Germany. Phone: 49-381-494-7700; Fax: 49-381-494-7702, E-mail: christoph.nienaber{at}med.uni-rostock.de

Background— Clinical profiles and outcomes of patients with acute type B aortic dissection have not been evaluated in the current era.

Methods and Results— Accordingly, we analyzed 384 patients (65±13 years, males 71%) with acute type B aortic dissection enrolled in the International Registry of Acute Aortic Dissection (IRAD). A majority of patients had hypertension and presented with acute chest/back pain. Only one-half showed abnormal findings on chest radiograph, and almost all patients had computerized tomography (CT), transesophageal echocardiography, magnetic resonance imaging (MRI), and/or aortogram to confirm the diagnosis. In-hospital mortality was 13% with most deaths occurring within the first week. Factors associated with increased in-hospital mortality on univariate analysis were hypotension/shock, widened mediastinum, periaortic hematoma, excessively dilated aorta (6 cm), in-hospital complications of coma/altered consciousness, mesenteric/limb ischemia, acute renal failure, and surgical management (all P<0.05). A risk prediction model with control for age and gender showed hypotension/shock (odds ratio [OR] 23.8, P<0.0001), absence of chest/back pain on presentation (OR 3.5, P=0.01), and branch vessel involvement (OR 2.9, P=0.02), collectively named ‘the deadly triad’ to be independent predictors of in-hospital death.

Conclusions— Our study provides insight into current-day profiles and outcomes of acute type B aortic dissection. Factors associated with increased in-hospital mortality ("the deadly triad") should be identified and taken into consideration for risk stratification and decision-making.

Key Words: aortic dissection • aorta • peripheral vascular disease • outcomes • stents

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