Geographic Differences in Clinical Presentation, Treatment, and Outcomes in Type A Acute Aortic Dissection (from the International Registry of Acute Aortic Dissection)

Arun Raghupathy, Christoph A. Nienaber, Kevin M. Harris, Truls Myrmel, Rossella Fattori, Udo Sechtem, Jae Kuen Oh, Santi Trimarchi, Jeanna V. Cooper, Anna Booher, Kim Eagle, Eric Isselbacher, Eduardo Bossone

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Although several studies have provided robust evidence about global differences for several cardiovascular emergencies, such as myocardial infarction and stroke, data were limited for aortic disease. The aim was to explore geographic variation in type A acute aortic dissection (TA-AAD) in a large group of consecutive patients. Patients (n = 615) from the IRAD with TA-AAD were studied with respect to presenting symptoms and signs, diagnosis, management, and outcomes in Europe versus North America. Compared with Europeans, North Americans were more likely to be older and present with atypical features and without many of the classic chest X-ray findings of AAD. In the North American cohort, electrocardiographic findings showed higher rates of nonspecific ST changes and a trend toward ST-elevation or new myocardial infarction (North Americans vs Europeans 7.9% vs 4.4%; p = 0.09). Use of imaging studies to confirm the diagnosis of AAD varied between North American and European centers. North American centers performed an average of 1.6 imaging studies compared with 1.8 in the European group (p = 0.002). Furthermore, they were significantly less likely to use computed tomography and significantly more likely to use transesophageal examination as part of the overall diagnostic algorithm. Compared with Europeans, TA-AAD occurred at smaller aortic diameters and there was a substantial delay to presentation and diagnosis in North Americans. No significant differences for early mortality rates were observed between the 2 groups. In conclusion, geographic differences in presentation and initial management were highlighted, but this did not translate into a difference in early mortality.

Original languageEnglish (US)
Pages (from-to)1562-1566
Number of pages5
JournalAmerican Journal of Cardiology
Volume102
Issue number11
DOIs
StatePublished - Dec 1 2008

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Registries
Dissection
Myocardial Infarction
Aortic Diseases
Mortality
North America
Signs and Symptoms
Emergencies
Thorax
Stroke
Tomography
X-Rays

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Geographic Differences in Clinical Presentation, Treatment, and Outcomes in Type A Acute Aortic Dissection (from the International Registry of Acute Aortic Dissection). / Raghupathy, Arun; Nienaber, Christoph A.; Harris, Kevin M.; Myrmel, Truls; Fattori, Rossella; Sechtem, Udo; Oh, Jae Kuen; Trimarchi, Santi; Cooper, Jeanna V.; Booher, Anna; Eagle, Kim; Isselbacher, Eric; Bossone, Eduardo.

In: American Journal of Cardiology, Vol. 102, No. 11, 01.12.2008, p. 1562-1566.

Research output: Contribution to journalArticle

Raghupathy, A, Nienaber, CA, Harris, KM, Myrmel, T, Fattori, R, Sechtem, U, Oh, JK, Trimarchi, S, Cooper, JV, Booher, A, Eagle, K, Isselbacher, E & Bossone, E 2008, 'Geographic Differences in Clinical Presentation, Treatment, and Outcomes in Type A Acute Aortic Dissection (from the International Registry of Acute Aortic Dissection)', American Journal of Cardiology, vol. 102, no. 11, pp. 1562-1566. https://doi.org/10.1016/j.amjcard.2008.07.049
Raghupathy, Arun ; Nienaber, Christoph A. ; Harris, Kevin M. ; Myrmel, Truls ; Fattori, Rossella ; Sechtem, Udo ; Oh, Jae Kuen ; Trimarchi, Santi ; Cooper, Jeanna V. ; Booher, Anna ; Eagle, Kim ; Isselbacher, Eric ; Bossone, Eduardo. / Geographic Differences in Clinical Presentation, Treatment, and Outcomes in Type A Acute Aortic Dissection (from the International Registry of Acute Aortic Dissection). In: American Journal of Cardiology. 2008 ; Vol. 102, No. 11. pp. 1562-1566.
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