title: Clinical profiles and outcomes of acute type B aortic dissection in the current era: lessons from the International Registry of Aortic Dissection (IRAD).
abstract: 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.
authors.affiliation: Division of Cardiology, University Hospital Rostock, Rostock School of Medicine, E.-Heydemann-Str. 6, 18057 Rostock, Germany.
authors.forename: Toru
authors.initials: T
authors.lastname: Suzuki
authors.forename: Rajendra H
authors.initials: RH
authors.lastname: Mehta
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Ince
authors.forename: Ryozo
authors.initials: R
authors.lastname: Nagai
authors.forename: Yasunari
authors.initials: Y
authors.lastname: Sakomura
authors.forename: Frank
authors.initials: F
authors.lastname: Weber
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Sumiyoshi
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
authors.forename: Santi
authors.initials: S
authors.lastname: Trimarchi
authors.forename: Jeanna V
authors.initials: JV
authors.lastname: Cooper
authors.forename: Dean E
authors.initials: DE
authors.lastname: Smith
authors.forename: Eric M
authors.initials: EM
authors.lastname: Isselbacher
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
mesh_terms: 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