Population-Based Assessment of the Incidence of Aortic Dissection, Intramural Hematoma, and Penetrating Ulcer, and Its Associated Mortality From 1995 to 2015

Abstract

Background: Aortic syndromes (AS), including aortic dissection (AD), intramural hematoma (IMH) and penetrating aortic ulcer (PAU), carry significant acute and long-term morbidity and mortality. However, the contemporary incidence and outcomes of AS are unknown. Methods and Results: We utilized the Rochester Epidemiology Project record linkage system to identify all Olmsted County, Minnesota, residents with AS (1995–2015). Diagnostic imaging, medical records, and death certificates were reviewed to confirm the diagnosis and AS subtype. Age- and sex-adjusted incidence rates were estimated using annual county-level census data. Survival for patients with AS was compared to age- and sex-matched controls using Cox regression to adjust for comorbid conditions. We identified 133 patients with AS (77-AD, 21-IMH, and 35-PAU). Average age was 71.8 years (SD 14.1) and 57% were male. The age- and sex-adjusted incidence was 7.7 per 100,000 person-years, was higher for males than females (10.2 vs. 5.7 per 100,000 person-years), and increased with age. Among subtypes, the incidence of AD was highest (4.4 per 100,000 person-years), while the incidence of PAU and IMH were lower (2.1 and 1.2 per 100,000 person-years). Overall, the incidence of AS was stable over time (p trend=.33), although the incidence of PAU appeared to increase from 0.6 to 2.6 per 100,000 person-years (p=.008) with variability over the study interval. Patients with AS had more than twice the mortality rate at 5, 10, and 20 years when compared to population-based controls (5, 10 and 20-year mortality 39%, 57%, 91% versus 18%, 41%, and 66%; overall adjusted mortality HR=2.1, p<0.001). Survival was lower than expected up to 90 days after AS diagnosis and did not differ significantly by subtype or by 5-year strata of diagnosis. Conclusions: Overall, the incidence of AD and IMH has remained stable since 1995, despite the decline noted for other cardiovascular disease. AS confers increased early and long-term mortality that has not changed. These data highlight the need to improve long term care to impact the prognosis of this patient group.

The usefulness of contrast‐enhanced echocardiography in the diagnosis and management of intramural hematoma and aortic dissection: A case report

“…Acute aortic syndrome, including AD, IMH, and PAU, is a potentially fatal pathologic process within the aortic wall 6 . Without timely intervention, the mortality rate of AD is as high as 1% per hour within 48 hours 7 . Therefore, prompt and accurate diagnosis is vital for patients’ management associated with the morbidity and mortality.…”

Acute type A aortic dissection in a young weightlifter: a case study with an in-depth literature review

“…Aortic dissection occurs when the tunica intima of the aorta develops a tear that extends into the inner two-third layer of its tunica media which consists of collagen, smooth muscle and elastic fibers. The above pathological changes lead to the formation of a true lumen and a false lumen separated by an intimal flab (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). This causes blood to escape into the false lumen and incite a cascade of events.…”

“…Peak age of onset is between 50-65 years. In a population-based study of all Olmsted County, Minnesota, residents with aortic dissection between 1995 to 2015, it was noted that age-and sex-adjusted incidence of aortic dissection for men was 10.2 per 100,000 person-years versus 5.7 per 100,000 person-years for women (1,(11)(12)(13)(14)46). Aortic dissection is commonly classified based on time of presentation and structural variations.…”

Barriers and Facilitators Affecting Implementation of a Clinical Decision aid for the Diagnosis of Acute Aortic Syndrome: A Qualitative Study

“…1 The low incidence of the condition, varied presenting symptoms, and lack of a standard diagnostic pathway has led to a misdiagnosis rate as high as 38%. [2][3][4] In order to address the di culties in the diagnosis of AAS, Ohle et al developed clinical practice guidelines for the diagnosis of AAS, including a decision aid for risk strati cation (see Additional le 1). 5 The purpose of the aid is to support clinical decision making in cases of suspected AAS, thereby minimizing diagnostic delays, misdiagnoses, and unnecessary advanced imaging.…”