title: International heterogeneity in diagnostic frequency and clinical outcomes of ascending aortic intramural hematoma.
abstract: BACKGROUND
  Differing diagnostic frequencies and management strategies for intramural hematoma (IMH) have been described in North American (NA)/European and Japanese/Korean studies.
  
  
  METHODS
  All publications including type-A aortic IMH were reviewed for details on patient demographics, treatment strategy, and clinical outcomes. Publications were stratified by the geographic region (NA/Europe or Japan/Korea).
  
  
  RESULTS
  IMH, as a percentage of aortic dissection, occurs more frequently in Japan/Korea versus NA/Europe (31.7% vs 10.9%, P < .0001). The proportion of patients treated with early medical therapy is greater in Japanese/Korean studies (77.9% vs 48.8% in NA/Europe, P < .0001). However, the overall mortality is significantly lower in Japan/Korea compared with NA/Europe (9.4% vs 20.6%, odds ratio = 2.80, P = .003) in part because of the lower mortality with early medical therapy (7.8% vs 33.3%, P < .0001).
  
  
  CONCLUSIONS
  There is significant international heterogeneity in the diagnosis and clinical outcomes of ascending IMH. IMH is diagnosed more frequently and has better overall outcomes in Japan/Korea.
authors.affiliation: Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
authors.forename: Jamie M
authors.initials: JM
authors.lastname: Pelzel
authors.forename: Alan C
authors.initials: AC
authors.lastname: Braverman
authors.forename: Alan T
authors.initials: AT
authors.lastname: Hirsch
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Harris
mesh_terms: D001011:Aorta / Q000000981:diagnostic imaging*; D001018:Aortic Diseases / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D017548:Echocardiography, Transesophageal / Q000706:statistics & numerical data*; D005060:Europe / Q000453:epidemiology; D006406:Hematoma / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D015994:Incidence; D038622:Internationality; D007564:Japan / Q000453:epidemiology; D007723:Korea / Q000453:epidemiology; D009656:North America / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome