The International Registry of Acute Aortic Dissection (IRAD): New insights into an old disease

Peter G. Hagan, Christoph A. Nienaber, Eric M. Isselbacher, David Bruckman, Dean J. Karavite, Pamela L. Russman, Arturo Evangelista, Rossella Fattori, Toru Suzuki, Jae Kuen Oh, Andrew G. Moore, Joseph F. Malouf, Linda A. Pape, Charlene Gaca, Udo Sechtem, Suzanne Lenferink, Hans Josef Deutsch, Holger Diedrichs, Jose Marcos y Robles, Alfredo LlovetDan Gilon, Sugata K. Das, William F. Armstrong, G. Michael Deeb, Kim A. Eagle

Research output: Contribution to journalArticle

2091 Citations (Scopus)

Abstract

Context. Acute aortic dissection is a life-threatening medical emergency associated with high rates of morbidity and mortality. Data are limited regarding the effect of recent imaging and therapeutic advances on patient care and outcomes in this setting. Objective. To assess the presentation, management, and outcomes of acute aortic dissection. Design. Case series with patients enrolled between January 1996 and December 1998. Data were collected at presentation and by physician review of hospital records. Setting. The International Registry of Acute Aortic Dissection, consisting of 12 international referral centers. Participants. A total of 464 patients (mean age 63 years 65.3% male) 62.3% of whom had type A dissection. Main Outcome Measures. Presenting history, physical findings, management, and mortality, as assessed by history and physician review of hospital records. Results. While sudden onset of severe sharp pain was the single most common presenting complaint, the clinical presentation was diverse. Classic physical findings such as aortic regurgitation and pulse deficit were noted in only 31.6% and 15.1% of patients, respectively, and initial chest radiograph and electrocardiogram were frequently not helpful (no abnormalities were noted in 12.4% and 31.3% of patients, respectively). Computed tomography was the initial imaging modality used in 61.1 %. Overall in-hospital mortality was 27.4%. Mortality of patients with type A dissection managed surgically was 26%; among those not receiving surgery (typically because of advanced age and comorbidity), mortality was 58%. Mortality of patients with type B dissection treated medically was 10.7%. Surgery was performed in 20% of patients with type B dissection; mortality in this group was 31.4%. Conclusions. Acute aortic dissection presents with a wide range of manifestations, and classic findings are often absent. A high clinical index of suspicion is necessary. Despite recent advances, in-hospital mortality rates remain high. Our data support the need for continued improvement in prevention, diagnosis, and management of acute aortic dissection.

Original languageEnglish (US)
Pages (from-to)897-903
Number of pages7
JournalJournal of the American Medical Association
Volume283
Issue number7
StatePublished - Feb 16 2000

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Registries
Dissection
Mortality
Hospital Records
Hospital Mortality
History
Physicians
Aortic Valve Insufficiency
Pulse
Comorbidity
Patient Care
Electrocardiography
Emergencies
Thorax
Referral and Consultation
Tomography
Outcome Assessment (Health Care)
Morbidity
Pain

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Hagan, P. G., Nienaber, C. A., Isselbacher, E. M., Bruckman, D., Karavite, D. J., Russman, P. L., ... Eagle, K. A. (2000). The International Registry of Acute Aortic Dissection (IRAD): New insights into an old disease. Journal of the American Medical Association, 283(7), 897-903.

The International Registry of Acute Aortic Dissection (IRAD) : New insights into an old disease. / Hagan, Peter G.; Nienaber, Christoph A.; Isselbacher, Eric M.; Bruckman, David; Karavite, Dean J.; Russman, Pamela L.; Evangelista, Arturo; Fattori, Rossella; Suzuki, Toru; Oh, Jae Kuen; Moore, Andrew G.; Malouf, Joseph F.; Pape, Linda A.; Gaca, Charlene; Sechtem, Udo; Lenferink, Suzanne; Deutsch, Hans Josef; Diedrichs, Holger; Marcos y Robles, Jose; Llovet, Alfredo; Gilon, Dan; Das, Sugata K.; Armstrong, William F.; Deeb, G. Michael; Eagle, Kim A.

In: Journal of the American Medical Association, Vol. 283, No. 7, 16.02.2000, p. 897-903.

Research output: Contribution to journalArticle

Hagan, PG, Nienaber, CA, Isselbacher, EM, Bruckman, D, Karavite, DJ, Russman, PL, Evangelista, A, Fattori, R, Suzuki, T, Oh, JK, Moore, AG, Malouf, JF, Pape, LA, Gaca, C, Sechtem, U, Lenferink, S, Deutsch, HJ, Diedrichs, H, Marcos y Robles, J, Llovet, A, Gilon, D, Das, SK, Armstrong, WF, Deeb, GM & Eagle, KA 2000, 'The International Registry of Acute Aortic Dissection (IRAD): New insights into an old disease', Journal of the American Medical Association, vol. 283, no. 7, pp. 897-903.
Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL et al. The International Registry of Acute Aortic Dissection (IRAD): New insights into an old disease. Journal of the American Medical Association. 2000 Feb 16;283(7):897-903.
Hagan, Peter G. ; Nienaber, Christoph A. ; Isselbacher, Eric M. ; Bruckman, David ; Karavite, Dean J. ; Russman, Pamela L. ; Evangelista, Arturo ; Fattori, Rossella ; Suzuki, Toru ; Oh, Jae Kuen ; Moore, Andrew G. ; Malouf, Joseph F. ; Pape, Linda A. ; Gaca, Charlene ; Sechtem, Udo ; Lenferink, Suzanne ; Deutsch, Hans Josef ; Diedrichs, Holger ; Marcos y Robles, Jose ; Llovet, Alfredo ; Gilon, Dan ; Das, Sugata K. ; Armstrong, William F. ; Deeb, G. Michael ; Eagle, Kim A. / The International Registry of Acute Aortic Dissection (IRAD) : New insights into an old disease. In: Journal of the American Medical Association. 2000 ; Vol. 283, No. 7. pp. 897-903.
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title = "The International Registry of Acute Aortic Dissection (IRAD): New insights into an old disease",
abstract = "Context. Acute aortic dissection is a life-threatening medical emergency associated with high rates of morbidity and mortality. Data are limited regarding the effect of recent imaging and therapeutic advances on patient care and outcomes in this setting. Objective. To assess the presentation, management, and outcomes of acute aortic dissection. Design. Case series with patients enrolled between January 1996 and December 1998. Data were collected at presentation and by physician review of hospital records. Setting. The International Registry of Acute Aortic Dissection, consisting of 12 international referral centers. Participants. A total of 464 patients (mean age 63 years 65.3{\%} male) 62.3{\%} of whom had type A dissection. Main Outcome Measures. Presenting history, physical findings, management, and mortality, as assessed by history and physician review of hospital records. Results. While sudden onset of severe sharp pain was the single most common presenting complaint, the clinical presentation was diverse. Classic physical findings such as aortic regurgitation and pulse deficit were noted in only 31.6{\%} and 15.1{\%} of patients, respectively, and initial chest radiograph and electrocardiogram were frequently not helpful (no abnormalities were noted in 12.4{\%} and 31.3{\%} of patients, respectively). Computed tomography was the initial imaging modality used in 61.1 {\%}. Overall in-hospital mortality was 27.4{\%}. Mortality of patients with type A dissection managed surgically was 26{\%}; among those not receiving surgery (typically because of advanced age and comorbidity), mortality was 58{\%}. Mortality of patients with type B dissection treated medically was 10.7{\%}. Surgery was performed in 20{\%} of patients with type B dissection; mortality in this group was 31.4{\%}. Conclusions. Acute aortic dissection presents with a wide range of manifestations, and classic findings are often absent. A high clinical index of suspicion is necessary. Despite recent advances, in-hospital mortality rates remain high. Our data support the need for continued improvement in prevention, diagnosis, and management of acute aortic dissection.",
author = "Hagan, {Peter G.} and Nienaber, {Christoph A.} and Isselbacher, {Eric M.} and David Bruckman and Karavite, {Dean J.} and Russman, {Pamela L.} and Arturo Evangelista and Rossella Fattori and Toru Suzuki and Oh, {Jae Kuen} and Moore, {Andrew G.} and Malouf, {Joseph F.} and Pape, {Linda A.} and Charlene Gaca and Udo Sechtem and Suzanne Lenferink and Deutsch, {Hans Josef} and Holger Diedrichs and {Marcos y Robles}, Jose and Alfredo Llovet and Dan Gilon and Das, {Sugata K.} and Armstrong, {William F.} and Deeb, {G. Michael} and Eagle, {Kim A.}",
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T1 - The International Registry of Acute Aortic Dissection (IRAD)

T2 - New insights into an old disease

AU - Hagan, Peter G.

AU - Nienaber, Christoph A.

AU - Isselbacher, Eric M.

AU - Bruckman, David

AU - Karavite, Dean J.

AU - Russman, Pamela L.

AU - Evangelista, Arturo

AU - Fattori, Rossella

AU - Suzuki, Toru

AU - Oh, Jae Kuen

AU - Moore, Andrew G.

AU - Malouf, Joseph F.

AU - Pape, Linda A.

AU - Gaca, Charlene

AU - Sechtem, Udo

AU - Lenferink, Suzanne

AU - Deutsch, Hans Josef

AU - Diedrichs, Holger

AU - Marcos y Robles, Jose

AU - Llovet, Alfredo

AU - Gilon, Dan

AU - Das, Sugata K.

AU - Armstrong, William F.

AU - Deeb, G. Michael

AU - Eagle, Kim A.

PY - 2000/2/16

Y1 - 2000/2/16

N2 - Context. Acute aortic dissection is a life-threatening medical emergency associated with high rates of morbidity and mortality. Data are limited regarding the effect of recent imaging and therapeutic advances on patient care and outcomes in this setting. Objective. To assess the presentation, management, and outcomes of acute aortic dissection. Design. Case series with patients enrolled between January 1996 and December 1998. Data were collected at presentation and by physician review of hospital records. Setting. The International Registry of Acute Aortic Dissection, consisting of 12 international referral centers. Participants. A total of 464 patients (mean age 63 years 65.3% male) 62.3% of whom had type A dissection. Main Outcome Measures. Presenting history, physical findings, management, and mortality, as assessed by history and physician review of hospital records. Results. While sudden onset of severe sharp pain was the single most common presenting complaint, the clinical presentation was diverse. Classic physical findings such as aortic regurgitation and pulse deficit were noted in only 31.6% and 15.1% of patients, respectively, and initial chest radiograph and electrocardiogram were frequently not helpful (no abnormalities were noted in 12.4% and 31.3% of patients, respectively). Computed tomography was the initial imaging modality used in 61.1 %. Overall in-hospital mortality was 27.4%. Mortality of patients with type A dissection managed surgically was 26%; among those not receiving surgery (typically because of advanced age and comorbidity), mortality was 58%. Mortality of patients with type B dissection treated medically was 10.7%. Surgery was performed in 20% of patients with type B dissection; mortality in this group was 31.4%. Conclusions. Acute aortic dissection presents with a wide range of manifestations, and classic findings are often absent. A high clinical index of suspicion is necessary. Despite recent advances, in-hospital mortality rates remain high. Our data support the need for continued improvement in prevention, diagnosis, and management of acute aortic dissection.

AB - Context. Acute aortic dissection is a life-threatening medical emergency associated with high rates of morbidity and mortality. Data are limited regarding the effect of recent imaging and therapeutic advances on patient care and outcomes in this setting. Objective. To assess the presentation, management, and outcomes of acute aortic dissection. Design. Case series with patients enrolled between January 1996 and December 1998. Data were collected at presentation and by physician review of hospital records. Setting. The International Registry of Acute Aortic Dissection, consisting of 12 international referral centers. Participants. A total of 464 patients (mean age 63 years 65.3% male) 62.3% of whom had type A dissection. Main Outcome Measures. Presenting history, physical findings, management, and mortality, as assessed by history and physician review of hospital records. Results. While sudden onset of severe sharp pain was the single most common presenting complaint, the clinical presentation was diverse. Classic physical findings such as aortic regurgitation and pulse deficit were noted in only 31.6% and 15.1% of patients, respectively, and initial chest radiograph and electrocardiogram were frequently not helpful (no abnormalities were noted in 12.4% and 31.3% of patients, respectively). Computed tomography was the initial imaging modality used in 61.1 %. Overall in-hospital mortality was 27.4%. Mortality of patients with type A dissection managed surgically was 26%; among those not receiving surgery (typically because of advanced age and comorbidity), mortality was 58%. Mortality of patients with type B dissection treated medically was 10.7%. Surgery was performed in 20% of patients with type B dissection; mortality in this group was 31.4%. Conclusions. Acute aortic dissection presents with a wide range of manifestations, and classic findings are often absent. A high clinical index of suspicion is necessary. Despite recent advances, in-hospital mortality rates remain high. Our data support the need for continued improvement in prevention, diagnosis, and management of acute aortic dissection.

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