TY - JOUR
T1 - Geographic Differences in Clinical Presentation, Treatment, and Outcomes in Type A Acute Aortic Dissection (from the International Registry of Acute Aortic Dissection)
AU - Raghupathy, Arun
AU - Nienaber, Christoph A.
AU - Harris, Kevin M.
AU - Myrmel, Truls
AU - Fattori, Rossella
AU - Sechtem, Udo
AU - Oh, Jae
AU - Trimarchi, Santi
AU - Cooper, Jeanna V.
AU - Booher, Anna
AU - Eagle, Kim
AU - Isselbacher, Eric
AU - Bossone, Eduardo
N1 - Funding Information:
Eduardo Bossone, MD, National Research Council, Lecce, Italy; Alan Braverman, MD, Washington University School of Medicine, St. Louis, Missouri; Stefanos Demertzis, MD, Cardiocentro Ticino, Lugano, Switzerland; Giuseppe DiBenedetto, MD, San Giovanni e Ruggi, Salerno, Italy; Mark Ehrlich, MD, University of Vienna, Vienna, Austria; Arturo Evangelista, MD, Hospital General Universitari Vall d'Hebron, Barcelona, Spain; Rossella Fattori, MD, University Hospital S. Orsola, Bologna, Italy; James Froehlich, MD, and Thomas Tsai, MD, University of Michigan, Ann Arbor, Michigan; Dan Gilon, MD, Hadassah University Hospital, Jerusalem, Israel; Alan Hirsch, MD, and Kevin Harris, MD, Minneapolis Heart Institute, Minneapolis, Minnesota; G. Chad Hughes, MD, Duke University, Durham, North Carolina; Stuart Hutchison, MD, St. Michael's Hospital, Toronto, Ontario, Canada; James L. Januzzi, MD, Massachusetts General Hospital, Boston, Massachusetts; Alfredo Llovet, MD, Hospital Universitario 12 de Octubre, Madrid, Spain; Truls Myrmel, MD, Tromsø University Hospital, Tromsø, Norway; Peter Oberwalder, MD, Medical School Graz, Graz, Austria; Patrick O'Gara, MD, and Joshua Beckman, MD, Brigham and Women's Hospital, Boston, Massachusetts; Jae K. Oh, MD, Mayo Clinic, Rochester, Minnesota; Linda A. Pape, MD, University of Massachusetts Hospital, Worcester, Massachusetts; Reed Pyeritz, MD, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Udo Sechtem, MD, and Gabriel Meinhardt, MD, Robert-Bosch Krankenhaus, Stuttgart, Germany; P. Gabriel Steg, MD, Hôpital Bichat, Paris, France; Toru Suzuki, MD, University of Tokyo, Tokyo, Japan; Santi Trimarchi, MD, IRCCS Policlinico San Donato, San Donato, Italy.
PY - 2008/12/1
Y1 - 2008/12/1
N2 - 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.
AB - 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.
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U2 - 10.1016/j.amjcard.2008.07.049
DO - 10.1016/j.amjcard.2008.07.049
M3 - Article
C2 - 19026315
AN - SCOPUS:56349160773
SN - 0002-9149
VL - 102
SP - 1562
EP - 1566
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 11
ER -