Aortic diameter >or = 5.5 cm is not a good predictor of type A aortic dissection: observations from the International Registry of Acute Aortic Dissection (IRAD).
BACKGROUND
Studies of aortic aneurysm patients have shown that the risk of rupture increases with aortic size. However, few studies of acute aortic dissection patients and aortic size exist. We used data from our registry of acute aortic dissection patients to better understand the relationship between aortic diameter and type A dissection.


RESULTS
We examined 591 type A dissection patients enrolled in the International Registry of Acute Aortic Dissection between 1996 and 2005 (mean age, 60.8 years). Maximum aortic diameters averaged 5.3 cm; 349 (59%) patients had aortic diameters <5.5 cm and 229 (40%) patients had aortic diameters <5.0 cm. Independent predictors of dissection at smaller diameters (<5.5 cm) included a history of hypertension (odds ratio, 2.17; 95% confidence interval, 1.03 to 4.57; P=0.04), radiating pain (odds ratio, 2.08; 95% confidence interval, 1.08 to 4.0; P=0.03), and increasing age (odds ratio, 1.03; 95% confidence interval, 1.00 to 1.05; P=0.03). Marfan syndrome patients were more likely to dissect at larger diameters (odds ratio, 14.3; 95% confidence interval, 2.7 to 100; P=0.002). Mortality (27% of patients) was not related to aortic size.


CONCLUSIONS
The majority of patients with acute type A acute aortic dissection present with aortic diameters <5.5 cm and thus do not fall within current guidelines for elective aneurysm surgery. Methods other than size measurement of the ascending aorta are needed to identify patients at risk for dissection.
Pape
Linda A
LA
University of Massachusetts Medical School, 55 Lake Ave N, Worcester, MA 01655, USA. linda.pape@umassmed.edu.
Tsai
Thomas T
TT
Isselbacher
Eric M
EM
Oh
Jae K
JK
O'gara
Patrick T
PT
Evangelista
Arturo
A
Fattori
Rossella
R
Meinhardt
Gabriel
G
Trimarchi
Santi
S
Bossone
Eduardo
E
Suzuki
Toru
T
Cooper
Jeanna V
JV
Froehlich
James B
JB
Nienaber
Christoph A
CA
Eagle
Kim A
KA
D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000473:pathology*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000473:pathology*; D001021:Aortic Valve / Q000473:pathology*; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012042:Registries