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Trimarchi S, Mandigers TJ, Bissacco D, Nienaber C, Isselbacher EM, Evangelista A, Suzuki T, Bossone E, Pape LA, Januzzi JL, Harris KM, O'Gara PT, Gilon D, Hutchison S, Patel HJ, Woznicki EM, Montgomery D, Kline-Rogers E, Eagle KA. Twenty-five years of observations from the International Registry of Acute Aortic Dissection (IRAD) and its impact on the cardiovascular scientific community. J Thorac Cardiovasc Surg 2023:S0022-5223(23)00608-6. [PMID: 37453718 DOI: 10.1016/j.jtcvs.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/21/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE The International Registry of Acute Aortic Dissection (IRAD) celebrated its 25th anniversary in January 2021. This study evaluated IRAD's role in promoting the understanding and management of acute aortic dissection (AD) over these years. METHODS IRAD studies were identified, analyzed, and ranked according to their citations per year (c/y) to determine the most-cited IRAD studies and topics. A systematic search of the literature identified cardiovascular guidelines on the diagnosis and management of acute AD. Consequently, IRAD's presence and impact were quantified using these documents. RESULTS Ninety-seven IRAD studies were identified, of which 82 obtained more than 10 cumulative citations. The median c/y index was 7.33 (25th-75th percentile, 4.01-16.65). Forty-two studies had a greater than median c/y index and were considered most impactful. Of these studies, most investigated both type A and type B AD (n = 17, 40.5%) and short-term outcomes (n = 26, 61.9%). Nineteen guideline documents were identified from 26 cardiovascular societies located in Northern America, Europe, and Japan. Sixty-nine IRAD studies were cited by these guidelines, including 38 of the 42 most-impactful IRAD studies. Among them, partial thrombosis of the false lumen as a predictor of postdischarge mortality and aortic diameters as a predictor of type A occurrence were determined as most-impactful specific IRAD topics by their c/y index. CONCLUSIONS IRAD has had and continues to have an important role in providing observations, credible knowledge, and research questions to improve the outcomes of patients with acute AD.
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Affiliation(s)
- Santi Trimarchi
- Section of Vascular Surgery, Cardio Thoracic Vascular Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
| | - Tim J Mandigers
- Section of Vascular Surgery, Cardio Thoracic Vascular Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Daniele Bissacco
- Section of Vascular Surgery, Cardio Thoracic Vascular Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Christoph Nienaber
- Department of Cardiology, Cardiology and Aortic Centre, The Royal Brompton & Harefield NHS Trust, Imperial College, London, United Kingdom
| | - Eric M Isselbacher
- Cardiology Department, Thoracic Aortic Center, Massachusetts General Hospital, Boston, Mass
| | - Arturo Evangelista
- Cardiology Department, Hospital General Universitari Vall d'Hebron, Barcelona, Spain
| | - Toru Suzuki
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | | | - Linda A Pape
- Department of Medicine, University of Massachusetts Hospital, Worcester, Mass
| | - James L Januzzi
- Cardiometabolic Trials, Baim Institute for Clinical Research, Boston, Mass; Cardiology Division, Massachusetts General Hospital, Boston, Mass
| | - Kevin M Harris
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minn
| | - Patrick T O'Gara
- Department of Cardiology, Brigham & Women's Hospital, Boston, Mass
| | - Dan Gilon
- Department of Non-invasive Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Stuart Hutchison
- Department of Cardiac Sciences, University of Calgary Medical Centre, Calgary, Canada
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | | | | | | | - Kim A Eagle
- Cardiovascular Center, University of Michigan, Ann Arbor, Mich
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2
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Arnaoutakis GJ, Ogami T, Patel HJ, Pai CW, Woznicki EM, Brinster DR, Leshnower BG, Serna-Gallegos D, Bekeredjian R, Sundt TM, Shaffer AW, Peterson MD, Geuzebroek GSC, Eagle KA, Trimarchi S, Sultan I. Acute Kidney Injury in Patients Undergoing Surgery for Type A Acute Aortic Dissection. Ann Thorac Surg 2023; 115:879-885. [PMID: 36370884 DOI: 10.1016/j.athoracsur.2022.10.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/27/2022] [Accepted: 10/17/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) after repair of type A acute aortic dissection (TAAAD) has been shown to affect both short- and long-term outcomes. This study aimed to validate the impact of postoperative AKI on in-hospital and long-term outcomes in a large population of dissection patients presenting to multinational aortic centers. Additionally, we assessed risk factors for AKI including surgical details. METHODS Patients undergoing surgical repair for TAAAD enrolled in the International Registry of Acute Aortic Dissection database were evaluated to determine the incidence and risk factors for the development of AKI. RESULTS A total of 3307 patients were identified. There were 761 (23%) patients with postoperative AKI (AKI group) vs 2546 patients without (77%, non-AKI group). The AKI group had a higher rate of in-hospital mortality (n = 193, 25.4% vs n = 122, 4.8% in the non-AKI group, P < .001). Additional postoperative complications were also more common in the AKI group including postoperative cerebrovascular accident, reexploration for bleeding, and prolonged ventilation. Independent baseline characteristics associated with AKI included a history of hypertension, diabetes, chronic kidney disease, evidence of malperfusion on presentation, distal extent of dissection to abdominal aorta, and longer cardiopulmonary bypass time. Kaplan-Meier survival curves revealed decreased 5-year survival among the AKI group (P < .001). CONCLUSIONS AKI occurs commonly after TAAAD repair and is associated with a significantly increased risk of operative and long-term mortality. In this large study using the International Registry of Acute Aortic Dissection database, several factors were elucidated that may affect risk of AKI.
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Affiliation(s)
- George J Arnaoutakis
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida Health, Gainesville, Florida
| | - Takuya Ogami
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan Cardiovascular Center, Ann Arbor, Michigan
| | - Chih-Wen Pai
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - Elise M Woznicki
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - Derek R Brinster
- Department of Cardiac Surgery, Northwell Health, New York, New York
| | - Bradley G Leshnower
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Derek Serna-Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Cardiothoracic Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Raffi Bekeredjian
- Department of Cardiology, Robert-Bosch Krankenhaus, Stuttgart, Germany
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrew W Shaffer
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Mark D Peterson
- Division of Cardiac Surgery, Department of Surgery, St Michael's Hospital, Toronto, Canada
| | - Guillaume S C Geuzebroek
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kim A Eagle
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - Santi Trimarchi
- Department of Vascular Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - University of Milan, Milan, Italy
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Cardiothoracic Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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3
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Harris KM, Nienaber CA, Peterson MD, Woznicki EM, Braverman AC, Trimarchi S, Myrmel T, Pyeritz R, Hutchison S, Strauss C, Ehrlich MP, Gleason TG, Korach A, Montgomery DG, Isselbacher EM, Eagle KA. Early Mortality in Type A Acute Aortic Dissection: Insights From the International Registry of Acute Aortic Dissection. JAMA Cardiol 2022; 7:1009-1015. [PMID: 36001309 PMCID: PMC9403853 DOI: 10.1001/jamacardio.2022.2718] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/06/2022] [Indexed: 11/14/2022]
Abstract
Importance Early data revealed a mortality rate of 1% to 2% per hour for type A acute aortic dissection (TAAAD) during the initial 48 hours. Despite advances in diagnostic testing and treatment, this mortality rate continues to be cited because of a lack of contemporary data characterizing early mortality and the effect of timely surgery. Objective To examine early mortality rates for patients with TAAAD in the contemporary era. Design, Setting, and Participants This cohort study examined data for patients with TAAAD in the International Registry of Acute Aortic Dissection between 1996 and 2018. Patients were grouped according to the mode of their intended treatment, surgical or medical. Exposure Surgical treatment. Main Outcomes and Measures Mortality was assessed in the initial 48 hours after hospital arrival using Kaplan-Meier curves. In-hospital complications were also evaluated. Results A total of 5611 patients with TAAAD were identified based on intended treatment: 5131 (91.4%) in the surgical group (3442 [67.1%] male; mean [SD] age, 60.4 [14.1] years) and 480 (8.6%) in the medical group (480 [52.5%] male; mean [SD] age, 70.9 [14.7] years). Reasons for medical management included advanced age (n = 141), comorbidities (n = 281), and patient preference (n = 81). Over the first 48 hours, the mortality for all patients in the study was 5.8%. Among patients who were medically managed, mortality was 0.5% per hour (23.7% at 48 hours). For those whose intended treatment was surgical, 48-hour mortality was 4.4%. In the surgical group, 51 patients (1%) died before the operation. Conclusions and Relevance In this study, the overall mortality rate for TAAAD was 5.8% at 48 hours. For patients in the medical group, TAAAD had a mortality rate of 0.5% per hour (23.7% at 48 hours). However, among those in the surgical group, 48-hour mortality decreased to 4.4%.
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Affiliation(s)
- Kevin M. Harris
- Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | | | - Mark D. Peterson
- Division of Cardiac Surgery, St Michaels Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Santi Trimarchi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | - Reed Pyeritz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Craig Strauss
- Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Marek P. Ehrlich
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Amit Korach
- Department of Cardiovascular Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | | | - Kim A. Eagle
- Cardiovascular Division, University of Michigan, Ann Arbor
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4
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Bossone E, Montgomery DG, Woznicki EM, Eagle KA. Shock and acute aortic dissection: A dangerous liaison. Am Heart J 2016; 181:e3-e4. [PMID: 27823700 DOI: 10.1016/j.ahj.2016.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | | | | | - Kim A Eagle
- Cardiovascular Center, University of Michigan, Ann Arbor, MI
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Chaddha A, Kline-Rogers E, Braverman AC, Erickson SR, Jackson EA, Franklin BA, Woznicki EM, Jabara JT, Montgomery DG, Eagle KA. Survivors of Aortic Dissection: Activity, Mental Health, and Sexual Function. Clin Cardiol 2016; 38:652-9. [PMID: 26769699 DOI: 10.1002/clc.22418] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 03/28/2015] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Currently no research exists assessing lifestyle modifications and emotional state of acute aortic dissection (AAD) survivors. We sought to assess activity, mental health, and sexual function in AAD survivors. HYPOTHESIS Physical and sexual activity will decrease in AAD survivors compared to pre-dissection. Incidence of anxiety and depression will be significant after AAD. METHODS A cross sectional survey was mailed to 197 subjects from a single academic medical center (part of larger IRAD database). Subjects were ≥18 years of age surviving a type A or B AAD between 1996 and 2011. 82 surveys were returned (overall response rate 42%). RESULTS Mean age ± SD was 59.5 ± 13.7 years, with 54.9% type A and 43.9% type B patients. Walking remained the most prevalent form of physical activity (49 (60%) pre-dissection and 47 (57%) post-dissection). Physical inactivity increased from 14 (17%) before AAD to 20 (24%) after AAD; sexual activity decreased from 31 (38%) to 9 (11%) mostly due to fear. Most patients (66.7%) were not exerting themselves physically or emotionally at AAD onset. Systolic blood pressure (SBP) at 36 months post-discharge for patients engaging in ≥2 sessions of aerobic activity/week was 126.67 ± 10.30 vs. 141.10 ± 11.87 (p-value 0.012) in those who did not. Self-reported new-onset depression after AAD was 32% and also 32% for new-onset anxiety. CONCLUSIONS Alterations in lifestyle and emotional state are frequent in AAD survivors. Clinicians should screen for unfounded fears or beliefs after dissection that may reduce function and/or quality of life for AAD survivors.
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Affiliation(s)
- Ashish Chaddha
- Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Eva Kline-Rogers
- Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Alan C Braverman
- Cardiovascular Division, Washington University, St. Louis, Missouri
| | | | | | - Barry A Franklin
- Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Elise M Woznicki
- Preventive Cardiology and Cardiology and Cardiac Rehabilitation, William Beaumont Hospital, Royal Oak, Michigan
| | - Justin T Jabara
- Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | | | - Kim A Eagle
- Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
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Chaddha A, Eagle KA, Braverman AC, Kline-Rogers E, Hirsch AT, Brook R, Jackson EA, Woznicki EM, Housholder-Hughes S, Pitler L, Franklin BA. Exercise and Physical Activity for the Post-Aortic Dissection Patient: The Clinician's Conundrum. Clin Cardiol 2016; 38:647-51. [PMID: 26769698 DOI: 10.1002/clc.22481] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/10/2015] [Indexed: 11/10/2022] Open
Abstract
Despite the paucity of evidence, it is often presumed, and is physiologically plausible, that sudden, acute elevations in blood pressure may transiently increase the risk of recurrent aortic dissection (AD) or rupture in patients with a prior AD, because a post-dissection aorta is almost invariably dilated and may thus experience greater associated wall stress as compared with a nondilated aorta. Few data are available regarding the specific types and intensities of exercise that may be both safe and beneficial for this escalating patient population. The purpose of this editorial/commentary is to further explore this conundrum for clinicians caring for and counseling AD survivors. Moderate-intensity cardiovascular activity may be cardioprotective in this patient cohort. It is likely that severe physical activity restrictions may reduce functional capacity and quality of life in post-AD patients and thus be harmful, underscoring the importance of further exploring the role of physical activity and/or structured exercise in this at-risk patient population.
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Affiliation(s)
- Ashish Chaddha
- Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Kim A Eagle
- Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Alan C Braverman
- Cardiovascular Division, Washington University, St. Louis, Missouri
| | - Eva Kline-Rogers
- Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Alan T Hirsch
- Cardiovascular Division, University of Minnesota Physicians Heart Practice, Minneapolis, Minnesota
| | - Robert Brook
- Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | | | - Elise M Woznicki
- Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | | | - Linda Pitler
- Thoracic Aortic Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Barry A Franklin
- Preventive Cardiology and Cardiac Rehabilitation, William Beaumont Hospital, Beaumont Health Center, Royal Oak, Michigan
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Chaddha A, Kline-Rogers E, Woznicki EM, Brook R, Housholder-Hughes S, Braverman AC, Pitler L, Hirsch AT, Eagle KA. Activity Recommendations for Postaortic Dissection Patients. Circulation 2014; 130:e140-2. [DOI: 10.1161/circulationaha.113.005819] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ashish Chaddha
- From the Cardiovascular Center, University of Michigan, Ann Arbor, MI (A.C., E.K.-R., E.M.W., R.B., S.H-H., K.A.E); the Cardiovascular Division, Washington University, St. Louis, MO (A.C.B.); the Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA (L.P.); and the Cardiovascular Division, University of Minnesota Physicians Heart Practice, Minneapolis, MN (A.T.H.)
| | - Eva Kline-Rogers
- From the Cardiovascular Center, University of Michigan, Ann Arbor, MI (A.C., E.K.-R., E.M.W., R.B., S.H-H., K.A.E); the Cardiovascular Division, Washington University, St. Louis, MO (A.C.B.); the Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA (L.P.); and the Cardiovascular Division, University of Minnesota Physicians Heart Practice, Minneapolis, MN (A.T.H.)
| | - Elise M. Woznicki
- From the Cardiovascular Center, University of Michigan, Ann Arbor, MI (A.C., E.K.-R., E.M.W., R.B., S.H-H., K.A.E); the Cardiovascular Division, Washington University, St. Louis, MO (A.C.B.); the Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA (L.P.); and the Cardiovascular Division, University of Minnesota Physicians Heart Practice, Minneapolis, MN (A.T.H.)
| | - Robert Brook
- From the Cardiovascular Center, University of Michigan, Ann Arbor, MI (A.C., E.K.-R., E.M.W., R.B., S.H-H., K.A.E); the Cardiovascular Division, Washington University, St. Louis, MO (A.C.B.); the Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA (L.P.); and the Cardiovascular Division, University of Minnesota Physicians Heart Practice, Minneapolis, MN (A.T.H.)
| | - Susan Housholder-Hughes
- From the Cardiovascular Center, University of Michigan, Ann Arbor, MI (A.C., E.K.-R., E.M.W., R.B., S.H-H., K.A.E); the Cardiovascular Division, Washington University, St. Louis, MO (A.C.B.); the Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA (L.P.); and the Cardiovascular Division, University of Minnesota Physicians Heart Practice, Minneapolis, MN (A.T.H.)
| | - Alan C. Braverman
- From the Cardiovascular Center, University of Michigan, Ann Arbor, MI (A.C., E.K.-R., E.M.W., R.B., S.H-H., K.A.E); the Cardiovascular Division, Washington University, St. Louis, MO (A.C.B.); the Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA (L.P.); and the Cardiovascular Division, University of Minnesota Physicians Heart Practice, Minneapolis, MN (A.T.H.)
| | - Linda Pitler
- From the Cardiovascular Center, University of Michigan, Ann Arbor, MI (A.C., E.K.-R., E.M.W., R.B., S.H-H., K.A.E); the Cardiovascular Division, Washington University, St. Louis, MO (A.C.B.); the Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA (L.P.); and the Cardiovascular Division, University of Minnesota Physicians Heart Practice, Minneapolis, MN (A.T.H.)
| | - Alan T. Hirsch
- From the Cardiovascular Center, University of Michigan, Ann Arbor, MI (A.C., E.K.-R., E.M.W., R.B., S.H-H., K.A.E); the Cardiovascular Division, Washington University, St. Louis, MO (A.C.B.); the Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA (L.P.); and the Cardiovascular Division, University of Minnesota Physicians Heart Practice, Minneapolis, MN (A.T.H.)
| | - Kim A. Eagle
- From the Cardiovascular Center, University of Michigan, Ann Arbor, MI (A.C., E.K.-R., E.M.W., R.B., S.H-H., K.A.E); the Cardiovascular Division, Washington University, St. Louis, MO (A.C.B.); the Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA (L.P.); and the Cardiovascular Division, University of Minnesota Physicians Heart Practice, Minneapolis, MN (A.T.H.)
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Dean JH, Woznicki EM, O'Gara P, Montgomery DG, Trimarchi S, Myrmel T, Pyeritz RE, Harris KM, Suzuki T, Braverman AC, Hughes GC, Kline-Rogers E, Nienaber CA, Isselbacher EM, Eagle KA, Bossone E. Cocaine-related aortic dissection: lessons from the International Registry of Acute Aortic Dissection. Am J Med 2014; 127:878-85. [PMID: 24835037 DOI: 10.1016/j.amjmed.2014.05.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 05/01/2014] [Accepted: 05/02/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Acute aortic dissection associated with cocaine use is rare and has been reported predominantly as single cases or in small patient cohorts. METHODS Our study analyzed 3584 patients enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2012. We divided the population on the basis of documented cocaine use (C+) versus non cocaine use (C-) and further stratified the cohorts into type A (33 C+/2332, 1.4%) and type B (30 C+/1252, 2.4%) dissection. RESULTS C+ patients presented at a younger age and were more likely to be male and black. Type B dissections were more common among C+ patients than in C- patients. Cocaine-related acute aortic dissection was reported more often at US sites than at European sites (86.4%, 51/63 vs 13.6%, 8/63; P < .001). Tobacco use was more prevalent in the C+ cohort. No differences were seen in history of hypertension, known atherosclerosis, or time from symptom onset to presentation. Type B C+ patients were more likely to be hypertensive at presentation. C+ patients had significantly smaller ascending aortic diameters at presentation. Acute renal failure was more common in type A C+ patients; however, mortality was significantly lower in type A C+ patients. CONCLUSIONS Cocaine use is implicated in 1.8% of patients with acute aortic dissection. The typical patient is relatively young and has the additional risk factors of hypertension and tobacco use. In-hospital mortality for those with cocaine-related type A dissection is lower than for those with non cocaine-related dissection, likely due to the younger age at presentation.
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Affiliation(s)
- Joshua H Dean
- Cardiovascular Center, University of Michigan, Ann Arbor
| | | | - Patrick O'Gara
- Cardiology Department, Brigham & Women's Hospital, Boston, Mass
| | | | - Santi Trimarchi
- Thoracic Aortic Research Center, IRCCS Policlinico San Donato, San Donato, Italy
| | - Truls Myrmel
- Department of Thoracic and Cardiovascular Surgery, Tromso University Hospital, Tromso, Norway
| | - Reed E Pyeritz
- Departments of Medicine and Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Kevin M Harris
- Cardiovascular Division, Minneapolis Heart Institute, Minneapolis, Minn
| | - Toru Suzuki
- Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | - Alan C Braverman
- Cardiovascular Division, Washington University School of Medicine, St Louis, Mo
| | - G Chad Hughes
- Division of Thoracic Cardiovascular Surgery, Duke University Medical Center, Durham, NC
| | | | - Christoph A Nienaber
- Division of Cardiology and Vascular Medicine, University of Rostock, Rostock, Germany
| | | | - Kim A Eagle
- Cardiovascular Center, University of Michigan, Ann Arbor
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9
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Brinza EK, Hagan L, Evangelista A, Isselbacher EM, Ehrlich MP, Fattori R, Trimarchi S, Hutchison S, Harris KM, Braverman AC, Woznicki EM, Montgomery DG, Eagle KA, Nienaber CA, Pape L. Abstract 274: Follow-Up of Young Acute Aortic Dissection Patients: How They Differ from Older Patients. Circ Cardiovasc Qual Outcomes 2013. [DOI: 10.1161/circoutcomes.6.suppl_1.a274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Young patients (pts) with acute aortic dissection (AAD) have distinct risk factors and presenting symptoms compared to older pts, but whether these differences extend past discharge is relatively unknown.
Methods:
Among pts presenting with AAD enrolled in the International Registry of Acute Aortic Dissection, pts <40 (N=280) were compared with pts ≥ 40 (N=3585). Chi-square analysis or Fischer’s Exact test were performed for categorical variables; age was compared using Student’s T-test. Kaplan-Meier curves were generated for freedom from adverse events rates 0-60 months following discharge. Mean follow-up was 28.6 months.
Results:
Significant differences in demographics and history were noted between pts <40 and the older cohort. Young pts more commonly had type A AAD (71.8%, 201/280, v. 64.6%, 2317/ 3585, p<0.016), while type B AAD was more typical in older pts (p<0.016). On imaging studies, pts <40 were less likely to present with IMH (7.3%, 246/3355, v. 2.3%, 6/266, p=0.002), but were more likely to have a patent false lumen (77.9%, 141/181, v. 62.1%, 1425/2295, p<0.001). Surgical management was more common in young pts, for both AAD types. In-hospital complications or mortality did not differ between groups. Kaplan-Meier analysis demonstrated better long-term survival in young pts compared to those ≥ 40 (p=0.029). Kaplan-Meier analyses of freedom from adverse events at 5 years illustrated no difference in aortic growth between groups, but significantly more late interventions in younger pts (p=0.006).
Conclusions:
Young pts show distinct differences in comparison to older pts, specifically regarding presentation, AAD type and management. Long-term survival and follow-up intervention rates are higher in young pts.
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Affiliation(s)
| | | | | | | | | | | | - Santi Trimarchi
- Thoracic Aortic Rsch Cntr, I.R.C.C.S. Policlinico San Donato, San Donato, Milan, Italy
| | | | | | | | | | | | | | | | - Linda Pape
- Univ of Massachusetts Hosp, Worcester, MA
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Harris KM, Braverman AC, Eagle KA, Woznicki EM, Pyeritz RE, Myrmel T, Peterson MD, Voehringer M, Fattori R, Januzzi JL, Gilon D, Montgomery DG, Nienaber CA, Trimarchi S, Isselbacher EM, Evangelista A. Acute aortic intramural hematoma: an analysis from the International Registry of Acute Aortic Dissection. Circulation 2012; 126:S91-6. [PMID: 22965999 DOI: 10.1161/circulationaha.111.084541] [Citation(s) in RCA: 148] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Acute aortic intramural hematoma (IMH) is an important subgroup of aortic dissection, and controversy surrounds appropriate management. METHODS AND RESULTS Patients with acute aortic syndromes in the International Registry of Acute Aortic Dissection (1996-2011) were evaluated to examine differences between patients (based on the initial imaging test) with IMH or classic dissection (AD). Of 2830 patients, 178 had IMH (64 type A [42%], 90 type B [58%], and 24 arch). Patients with IMH were older and presented with similar symptoms, such as severe pain. Patients with type A IMH were less likely to present with aortic regurgitation or pulse deficits and were more likely to have periaortic hematoma and pericardial effusion. Although type A IMH and AD were managed medically infrequently, type B IMH were more frequently treated medically. Overall in-hospital mortality was not statistically different for type A IMH compared to AD (26.6% versus 26.5%; P=0.998); type A IMH managed medically had significant mortality (40.0%), although less than classic AD (61.8%; P=0.195). Patients with type B IMH had a hospital mortality that was less but did not differ significantly (4.4% versus 11.1%; P=0.062) from classic AD. One-year mortality was not significantly different between AD and IMH. CONCLUSIONS Acute IMH has similar presentation to classic AD but is more frequently complicated with pericardial effusions and periaortic hematoma. Patients with IMH have a mortality that does not differ statistically from those with classic AD. A small subgroup of type A IMH patients are managed medically and have a significant in-hospital mortality.
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Affiliation(s)
- Kevin M Harris
- Minneapolis Heart Institute Foundation, Abbott-Northwestern Hospital, Minneapolis, MN 55407, USA.
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Fattori R, Isselbacher EM, Nienaber CA, Froehlich JB, Evangelista A, Januzzi JL, Strauss C, Jondeau G, Cooper JV, Montgomery DG, Woznicki EM, Bartnes K, Suzuki T, Braverman AC, Eagle KA. CHARACTERISTICS OF AORTIC DISSECTION IN PATIENTS WITH BICUSPID AORTIC VALVE: INSIGHTS FROM THE INTERNATIONAL REGISTRY OF ACUTE AORTIC DISSECTION (IRAD). J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)61515-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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