Population-Based Study of Incidence and Outcome of Acute Aortic Dissection and Pre-Morbid Risk-Factor Control: 10-Year Results from the Oxford Vascular Study
Background—Acute aortic dissection is a preventable life-threatening condition. However, there have been no prospective population-based studies of incidence or outcome to inform understanding of risk factors, strategies for prevention, or projections for future clinical service provision.
Methods and Results—We prospectively determined incidence and outcomes of all acute aortic dissections in a population of 92,728 in Oxfordshire, UK, during 2002-2012. Among 154 patients with 173 acute aortic events, 54 patients had 59 thoraco-abdominal aortic dissections (52 incident events - 6/100,000, 95%CI 4-7; 37 Stanford type-A, 15 type-B; 31 men, mean age =72.0yrs). Among patients with type-A incident events, 18 (48.6%) died prior to hospital assessment (61.1% women). The 30-day fatality rate was 47.4% for type-A cases who survived to hospital admission and 13.3% for type-B cases, although subsequent 5-year survival rates were high (85.7% for type-A; 83.3% for type-B). Even though 67.3% of patients were on antihypertensive drugs, 46.0% of all patients had at least one systolic-BP ≥180 mmHg in their primary-care records over the preceding 5 years, and the proportion of BPs in the hypertensive range (>140/90 mmHg) averaged 56.0%. Premorbid BP was higher in patients with Type-A dissections that were immediately fatal than in those who survived to admission (mean/SD pre-event SBP = 151.2/19.3 vs 137.9/17.9; p<0.001).
Conclusions—Uncontrolled hypertension remains the most significant treatable risk factor for acute aortic dissection. Prospective population-based ascertainment showed that hospital-based registries will underestimate not only incidence and case-fatality but also the association with pre-morbid hypertension.
- Received December 7, 2012.
- Revision received February 26, 2013.
- Accepted April 5, 2013.