Incidence, presentation and outcome of acute aortic dissection: results from a population-based study

IF 2.8 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Open Heart Pub Date : 2024-03-01 DOI:10.1136/openhrt-2023-002595

Christian Smedberg, Rebecka Hultgren, Christian Olsson, Johnny Steuer

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Abstract

Objectives To describe the incidence of acute aortic dissection in a clearly defined population, to assess onset symptoms and admission biochemical marker levels and to analyse variables potentially associated to mortality. Methods Medical records and CT angiograms of all patients hospitalised for acute aortic dissection in the Stockholm County during the 5-year period 2012–2016 were reviewed. The patients were followed until date of death or until 31 December 2020. The annual incidence was determined. Associations between clinical and biochemical variables and 30-day mortality, respectively, were analysed using multivariable logistic regression models. Results A total of 344 patients were included. The mean annual incidence of acute aortic dissection was 4.1 per 100 000. Median age was 67 years (range 24–91) and 34% (n=118) were women. Type A dissection was predominant; 220 patients (64%) had type A and 124 (36%) had type B. Painless dissection was more common in type A than in type B (18% vs 15%, p=0.003). Type A dissection patients also more commonly had elevated plasma troponin T (44% vs 21%, p<0.001) and thrombocytopenia (26% vs 15%, p=0.010) than type B dissection patients on admission. Overall, 30-day mortality was 28% in type A and 11% in type B (p<0.001). Both painless dissection (OR 4.30, 95% CI 1.80 to 10.28, p=0.001) and elevated troponin T (OR 3.78, 95% CI 2.01 to 7.12, p<0.001), respectively, were associated with increased 30-day mortality in all acute aortic dissection patients. Thrombocytopenia was associated with elevated 30-day mortality only in patients with type A (OR 3.09, 95% CI 1.53 to 6.21, p=0.002). Conclusions Nearly two-thirds of acute aortic dissection patients had type A. Levels of troponin T and platelets, respectively, paired with presence or absence of typical symptoms may become useful adjuncts in risk stratification of patients with acute aortic dissection. Data are available upon reasonable request. Deidentified participant data. Contact details: orc-id 0000-0003-1326-3945.

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急性主动脉夹层的发病率、表现和预后：基于人群的研究结果

目的描述明确界定的人群中急性主动脉夹层的发病率，评估发病症状和入院生化标志物水平，并分析可能与死亡率相关的变量。方法回顾性分析斯德哥尔摩县 2012-2016 年 5 年间所有因急性主动脉夹层住院患者的病历和 CT 血管造影。对患者进行随访，直至死亡日期或 2020 年 12 月 31 日。确定了年发病率。采用多变量逻辑回归模型分别分析了临床和生化变量与 30 天死亡率之间的关系。结果共纳入 344 名患者。急性主动脉夹层的年平均发病率为每十万人中 4.1 例。中位年龄为 67 岁（24-91 岁不等），34%（n=118）为女性。无痛性夹层在 A 型中比在 B 型中更常见（18% 对 15%，P=0.003）。A 型夹层患者入院时血浆肌钙蛋白 T 升高（44% 对 21%，P<0.001）和血小板减少（26% 对 15%，P=0.010）的情况也多于 B 型夹层患者。总体而言，A 型患者的 30 天死亡率为 28%，B 型患者为 11%（P<0.001）。在所有急性主动脉夹层患者中，无痛夹层（OR 4.30，95% CI 1.80 至 10.28，p=0.001）和肌钙蛋白 T 升高（OR 3.78，95% CI 2.01 至 7.12，p<0.001）分别与 30 天死亡率升高有关。只有 A 型患者的血小板减少与 30 天死亡率升高有关（OR 3.09，95% CI 1.53 至 6.21，P=0.002）。肌钙蛋白 T 和血小板的水平分别与有无典型症状配对，可能成为对急性主动脉夹层患者进行风险分层的有用辅助指标。如有合理要求，可提供相关数据。参与者数据已去身份化。联系方式：ORC-ID 0000-0003-1326-3945。

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来源期刊

Open Heart CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.60

自引率

3.70%

发文量

145

审稿时长

20 weeks

期刊介绍： Open Heart is an online-only, open access cardiology journal that aims to be “open” in many ways: open access (free access for all readers), open peer review (unblinded peer review) and open data (data sharing is encouraged). The goal is to ensure maximum transparency and maximum impact on research progress and patient care. The journal is dedicated to publishing high quality, peer reviewed medical research in all disciplines and therapeutic areas of cardiovascular medicine. Research is published across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Opinionated discussions on controversial topics are welcomed. Open Heart aims to operate a fast submission and review process with continuous publication online, to ensure timely, up-to-date research is available worldwide. The journal adheres to a rigorous and transparent peer review process, and all articles go through a statistical assessment to ensure robustness of the analyses. Open Heart is an official journal of the British Cardiovascular Society.