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

Randall R De Martino, Indrani Sen, Ying Huang, Thomas C. Bower, Gustavo Oderich, Alberto Pochettino, Kevin Greason, Manju Kalra, Jill Johnstone, Fahad Shuja, W. Scott Harmsen, Thanila Macedo, Jayawant Mandrekar, Alanna Chamberlain, Salome Weiss, Philip P. Goodney, Veronique Lee Roger

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background Aortic syndromes (ASs), including aortic dissection, intramural hematoma, and penetrating aortic ulcer, carry significant acute and long-term morbidity and mortality. However, the contemporary incidence and outcomes of AS are unknown. Methods and Results We used the Rochester Epidemiology Project record linkage system to identify all Olmsted County, MN, 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 with age- and sex-matched controls using Cox regression to adjust for comorbid conditions. We identified 133 patients with AS (77, aortic dissection; 21, intramural hematoma; and 35, penetrating aortic ulcer). Average age was 71.8 years (SD=14.1), and 57% were men. The age- and sex-adjusted incidence was 7.7 per 100 000 person-years, was higher for men than women (10.2 versus 5.7 per 100 000 person-years), and increased with age. Among subtypes, the incidence of aortic dissection was highest (4.4 per 100 000 person-years), whereas the incidence of penetrating aortic ulcer and intramural hematoma was lower (2.1 and 1.2 per 100 000 person-years). Overall, the incidence of AS was stable over time ( P trend=0.33), although the incidence of penetrating aortic ulcer seemed to increase from 0.6 to 2.6 per 100 000 person-years ( P=0.008) with variability over the study interval. Patients with AS had more than twice the mortality rate at 5, 10, and 20 years when compared with population-based controls (5-, 10-, and 20-year mortality 39%, 57%, and 91% versus 18%, 41%, and 66%; overall adjusted mortality hazards ratio=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 aortic dissection and intramural hematoma 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.

Original languageEnglish (US)
Pages (from-to)e004689
JournalCirculation. Cardiovascular quality and outcomes
Volume11
Issue number8
DOIs
StatePublished - Aug 1 2018
Externally publishedYes

Fingerprint

Hematoma
Ulcer
Dissection
Mortality
Incidence
Population
Death Certificates
Population Control
Survival
Long-Term Care
Censuses
Diagnostic Imaging
Medical Records
Epidemiology
Cardiovascular Diseases
Morbidity

Keywords

  • dissection
  • epidemiology
  • hematoma
  • incidence
  • syndrome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Population-Based Assessment of the Incidence of Aortic Dissection, Intramural Hematoma, and Penetrating Ulcer, and Its Associated Mortality From 1995 to 2015. / De Martino, Randall R; Sen, Indrani; Huang, Ying; Bower, Thomas C.; Oderich, Gustavo; Pochettino, Alberto; Greason, Kevin; Kalra, Manju; Johnstone, Jill; Shuja, Fahad; Harmsen, W. Scott; Macedo, Thanila; Mandrekar, Jayawant; Chamberlain, Alanna; Weiss, Salome; Goodney, Philip P.; Roger, Veronique Lee.

In: Circulation. Cardiovascular quality and outcomes, Vol. 11, No. 8, 01.08.2018, p. e004689.

Research output: Contribution to journalArticle

De Martino, Randall R ; Sen, Indrani ; Huang, Ying ; Bower, Thomas C. ; Oderich, Gustavo ; Pochettino, Alberto ; Greason, Kevin ; Kalra, Manju ; Johnstone, Jill ; Shuja, Fahad ; Harmsen, W. Scott ; Macedo, Thanila ; Mandrekar, Jayawant ; Chamberlain, Alanna ; Weiss, Salome ; Goodney, Philip P. ; Roger, Veronique Lee. / Population-Based Assessment of the Incidence of Aortic Dissection, Intramural Hematoma, and Penetrating Ulcer, and Its Associated Mortality From 1995 to 2015. In: Circulation. Cardiovascular quality and outcomes. 2018 ; Vol. 11, No. 8. pp. e004689.
@article{b4a2bbf8e1754024b8f2aaabc5bfc5d0,
title = "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 (ASs), including aortic dissection, intramural hematoma, and penetrating aortic ulcer, carry significant acute and long-term morbidity and mortality. However, the contemporary incidence and outcomes of AS are unknown. Methods and Results We used the Rochester Epidemiology Project record linkage system to identify all Olmsted County, MN, 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 with age- and sex-matched controls using Cox regression to adjust for comorbid conditions. We identified 133 patients with AS (77, aortic dissection; 21, intramural hematoma; and 35, penetrating aortic ulcer). Average age was 71.8 years (SD=14.1), and 57{\%} were men. The age- and sex-adjusted incidence was 7.7 per 100 000 person-years, was higher for men than women (10.2 versus 5.7 per 100 000 person-years), and increased with age. Among subtypes, the incidence of aortic dissection was highest (4.4 per 100 000 person-years), whereas the incidence of penetrating aortic ulcer and intramural hematoma was lower (2.1 and 1.2 per 100 000 person-years). Overall, the incidence of AS was stable over time ( P trend=0.33), although the incidence of penetrating aortic ulcer seemed to increase from 0.6 to 2.6 per 100 000 person-years ( P=0.008) with variability over the study interval. Patients with AS had more than twice the mortality rate at 5, 10, and 20 years when compared with population-based controls (5-, 10-, and 20-year mortality 39{\%}, 57{\%}, and 91{\%} versus 18{\%}, 41{\%}, and 66{\%}; overall adjusted mortality hazards ratio=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 aortic dissection and intramural hematoma 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.",
keywords = "dissection, epidemiology, hematoma, incidence, syndrome",
author = "{De Martino}, {Randall R} and Indrani Sen and Ying Huang and Bower, {Thomas C.} and Gustavo Oderich and Alberto Pochettino and Kevin Greason and Manju Kalra and Jill Johnstone and Fahad Shuja and Harmsen, {W. Scott} and Thanila Macedo and Jayawant Mandrekar and Alanna Chamberlain and Salome Weiss and Goodney, {Philip P.} and Roger, {Veronique Lee}",
year = "2018",
month = "8",
day = "1",
doi = "10.1161/CIRCOUTCOMES.118.004689",
language = "English (US)",
volume = "11",
pages = "e004689",
journal = "Circulation: Cardiovascular Quality and Outcomes",
issn = "1941-7713",
publisher = "Lippincott Williams and Wilkins",
number = "8",

}

TY - JOUR

T1 - Population-Based Assessment of the Incidence of Aortic Dissection, Intramural Hematoma, and Penetrating Ulcer, and Its Associated Mortality From 1995 to 2015

AU - De Martino, Randall R

AU - Sen, Indrani

AU - Huang, Ying

AU - Bower, Thomas C.

AU - Oderich, Gustavo

AU - Pochettino, Alberto

AU - Greason, Kevin

AU - Kalra, Manju

AU - Johnstone, Jill

AU - Shuja, Fahad

AU - Harmsen, W. Scott

AU - Macedo, Thanila

AU - Mandrekar, Jayawant

AU - Chamberlain, Alanna

AU - Weiss, Salome

AU - Goodney, Philip P.

AU - Roger, Veronique Lee

PY - 2018/8/1

Y1 - 2018/8/1

N2 - Background Aortic syndromes (ASs), including aortic dissection, intramural hematoma, and penetrating aortic ulcer, carry significant acute and long-term morbidity and mortality. However, the contemporary incidence and outcomes of AS are unknown. Methods and Results We used the Rochester Epidemiology Project record linkage system to identify all Olmsted County, MN, 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 with age- and sex-matched controls using Cox regression to adjust for comorbid conditions. We identified 133 patients with AS (77, aortic dissection; 21, intramural hematoma; and 35, penetrating aortic ulcer). Average age was 71.8 years (SD=14.1), and 57% were men. The age- and sex-adjusted incidence was 7.7 per 100 000 person-years, was higher for men than women (10.2 versus 5.7 per 100 000 person-years), and increased with age. Among subtypes, the incidence of aortic dissection was highest (4.4 per 100 000 person-years), whereas the incidence of penetrating aortic ulcer and intramural hematoma was lower (2.1 and 1.2 per 100 000 person-years). Overall, the incidence of AS was stable over time ( P trend=0.33), although the incidence of penetrating aortic ulcer seemed to increase from 0.6 to 2.6 per 100 000 person-years ( P=0.008) with variability over the study interval. Patients with AS had more than twice the mortality rate at 5, 10, and 20 years when compared with population-based controls (5-, 10-, and 20-year mortality 39%, 57%, and 91% versus 18%, 41%, and 66%; overall adjusted mortality hazards ratio=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 aortic dissection and intramural hematoma 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.

AB - Background Aortic syndromes (ASs), including aortic dissection, intramural hematoma, and penetrating aortic ulcer, carry significant acute and long-term morbidity and mortality. However, the contemporary incidence and outcomes of AS are unknown. Methods and Results We used the Rochester Epidemiology Project record linkage system to identify all Olmsted County, MN, 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 with age- and sex-matched controls using Cox regression to adjust for comorbid conditions. We identified 133 patients with AS (77, aortic dissection; 21, intramural hematoma; and 35, penetrating aortic ulcer). Average age was 71.8 years (SD=14.1), and 57% were men. The age- and sex-adjusted incidence was 7.7 per 100 000 person-years, was higher for men than women (10.2 versus 5.7 per 100 000 person-years), and increased with age. Among subtypes, the incidence of aortic dissection was highest (4.4 per 100 000 person-years), whereas the incidence of penetrating aortic ulcer and intramural hematoma was lower (2.1 and 1.2 per 100 000 person-years). Overall, the incidence of AS was stable over time ( P trend=0.33), although the incidence of penetrating aortic ulcer seemed to increase from 0.6 to 2.6 per 100 000 person-years ( P=0.008) with variability over the study interval. Patients with AS had more than twice the mortality rate at 5, 10, and 20 years when compared with population-based controls (5-, 10-, and 20-year mortality 39%, 57%, and 91% versus 18%, 41%, and 66%; overall adjusted mortality hazards ratio=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 aortic dissection and intramural hematoma 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.

KW - dissection

KW - epidemiology

KW - hematoma

KW - incidence

KW - syndrome

UR - http://www.scopus.com/inward/record.url?scp=85055598819&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055598819&partnerID=8YFLogxK

U2 - 10.1161/CIRCOUTCOMES.118.004689

DO - 10.1161/CIRCOUTCOMES.118.004689

M3 - Article

C2 - 30354376

AN - SCOPUS:85055598819

VL - 11

SP - e004689

JO - Circulation: Cardiovascular Quality and Outcomes

JF - Circulation: Cardiovascular Quality and Outcomes

SN - 1941-7713

IS - 8

ER -