Role of age in acute type A aortic dissection outcome: report from the International Registry of Acute Aortic Dissection (IRAD).
OBJECTIVE
The increasing life expectancy of the population will likely be accompanied by a rise in the incidence of acute type A aortic dissection. However, because of an increased risk of cardiac surgery in an elderly population, it is important to define when, if at all, the risks of aortic repair outweigh the risk of death from unoperated type A aortic dissection.


METHODS
We analyzed 936 patients with type A aortic dissection enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2004. Patients with type A aortic dissection were categorized according to patient age by decade and by surgical versus medical management, and outcomes of both management types were investigated in the different age groups.


RESULTS
The rate of surgical aortic repair decreased progressively with age, whereas surgical mortality significantly increased with age. Age 70 years or more was an independent predictor for mortality (38.2% vs 26.0%; P < .0001, odds ratio 1.73). The in-hospital mortality rate was significantly lower after surgical management compared with medical management until the age of 80 years. For patients aged 80 to 90 years, the in-hospital mortality appeared to be lower after surgical management (37.9% vs 55.2%; P = .188); however, this failed to reach clinical significance owing to the limited patient number in this age group.


CONCLUSIONS
Although the surgical mortality significantly increased with increased age, surgical management was still associated with significantly lower in-hospital mortality rates compared with medical management until the age of 80 years. Surgery may decrease the in-hospital mortality rate for octogenarians with type A aortic dissection and might be considered in all patients with type A aortic dissection regardless of age.
Trimarchi
Santi
S
Policlinico San Donato IRCCS, San Donato Milanese, Italy. santi.trimarchi@unimi.it
Eagle
Kim A
KA
Nienaber
Christoph A
CA
Rampoldi
Vincenzo
V
Jonker
Frederik H W
FH
De Vincentiis
Carlo
C
Frigiola
Alessandro
A
Menicanti
Lorenzo
L
Tsai
Thomas
T
Froehlich
Jim
J
Evangelista
Arturo
A
Montgomery
Daniel
D
Bossone
Eduardo
E
Cooper
Jeanna V
JV
Li
Jin
J
Deeb
Michael G
MG
Meinhardt
Gabriel
G
Sundt
Thoralf M
TM
Isselbacher
Eric M
EM
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000628:therapy*; D001014:Aortic Aneurysm / Q000401:mortality / Q000628:therapy*; D001208:Asia; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D005060:Europe; D017052:Hospital Mortality; D006801:Humans; D016017:Odds Ratio; D018579:Patient Selection; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality
D002317:Cardiovascular Agents