Clinical profiles and outcomes of acute type B aortic dissection in the current era: lessons from the International Registry of Aortic Dissection (IRAD).
BACKGROUND
Clinical profiles and outcomes of patients with acute type B aortic dissection have not been evaluated in the current era.


RESULTS
Accordingly, we analyzed 384 patients (65+/-13 years, males 71%) with acute type B aortic dissection enrolled in the International Registry of Acute Aortic Dissection (IRAD). A majority of patients had hypertension and presented with acute chest/back pain. Only one-half showed abnormal findings on chest radiograph, and almost all patients had computerized tomography (CT), transesophageal echocardiography, magnetic resonance imaging (MRI), and/or aortogram to confirm the diagnosis. In-hospital mortality was 13% with most deaths occurring within the first week. Factors associated with increased in-hospital mortality on univariate analysis were hypotension/shock, widened mediastinum, periaortic hematoma, excessively dilated aorta (>or=6 cm), in-hospital complications of coma/altered consciousness, mesenteric/limb ischemia, acute renal failure, and surgical management (all P<0.05). A risk prediction model with control for age and gender showed hypotension/shock (odds ratio [OR] 23.8, P<0.0001), absence of chest/back pain on presentation (OR 3.5, P=0.01), and branch vessel involvement (OR 2.9, P=0.02), collectively named 'the deadly triad' to be independent predictors of in-hospital death.


CONCLUSIONS
Our study provides insight into current-day profiles and outcomes of acute type B aortic dissection. Factors associated with increased in-hospital mortality ("the deadly triad") should be identified and taken into consideration for risk stratification and decision-making.
Suzuki
Toru
T
Division of Cardiology, University Hospital Rostock, Rostock School of Medicine, E.-Heydemann-Str. 6, 18057 Rostock, Germany.
Mehta
Rajendra H
RH
Ince
Hüseyin
H
Nagai
Ryozo
R
Sakomura
Yasunari
Y
Weber
Frank
F
Sumiyoshi
Tetsuya
T
Bossone
Eduardo
E
Trimarchi
Santi
S
Cooper
Jeanna V
JV
Smith
Dean E
DE
Isselbacher
Eric M
EM
Eagle
Kim A
KA
Nienaber
Christoph A
CA
D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D001014:Aortic Aneurysm / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome