title: Presentation, Diagnosis, and Outcomes of Acute Aortic Dissection: 17-Year Trends From the International Registry of Acute Aortic Dissection.
abstract: BACKGROUND
  Diagnosis, treatment, and outcomes of acute aortic dissection (AAS) are changing.
  
  
  OBJECTIVE
  This study examined 17-year trends in the presentation, diagnosis, and hospital outcomes of AAD from the International Registry of Acute Aortic Dissection (IRAD).
  
  
  METHODS
  Data from 4,428 patients enrolled at 28 IRAD centers between December 26, 1995, and February 6, 2013, were analyzed. Patients were divided according to enrollment date into 6 equal groups and by AAD type: A (n = 2,952) or B (n = 1,476).
  
  
  RESULTS
  There was no change in the presenting complaints of severe or worst-ever pain for type A and type B AAD (93% and 94%, respectively), nor in the incidence of chest pain (83% and 71%, respectively). Use of computed tomography (CT) for diagnosis of type A increased from 46% to 73% (p < 0.001). Surgical management for type A increased from 79% to 90% (p < 0.001). Endovascular management of type B increased from 7% to 31% (p < 0.001). Type A in-hospital mortality decreased significantly (31% to 22%; p < 0.001), as surgical mortality (25% to 18%; p = 0.003). There was no significant trend in in-hospital mortality in type B (from 12% to 14%).
  
  
  CONCLUSIONS
  Presenting symptoms and physical findings of AAD have not changed significantly. Use of chest CT increased for type A. More patients in both groups were managed with interventional procedures: surgery in type A and endovascular therapy in type B. A significant decrease in overall in-hospital mortality was seen for type A but not for type B.
authors.affiliation: Department of Medicine, University of Massachusetts Hospital, Worcester, Massachusetts. Electronic address: linda.pape@umassmed.edu.
authors.forename: Linda A
authors.initials: LA
authors.lastname: Pape
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, Botsford Hospital, Farmington Hills, Michigan.
authors.forename: Mazen
authors.initials: M
authors.lastname: Awais
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Elise M
authors.initials: EM
authors.lastname: Woznicki
authors.affiliation: Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Research Center for Thoracic Aortic Diseases, IRCCS Policlinico San Donato, San Donato, Italy.
authors.forename: Santi
authors.initials: S
authors.lastname: Trimarchi
authors.affiliation: Servei de Cardiologia, Hospital General Universitari Vall D'Hebron, Barcelona, Spain.
authors.forename: Arturo
authors.initials: A
authors.lastname: Evangelista
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Tromso University Hospital, Tromso, Norway.
authors.forename: Truls
authors.initials: T
authors.lastname: Myrmel
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Tromso University Hospital, Tromso, Norway.
authors.forename: Magnus
authors.initials: M
authors.lastname: Larsen
authors.affiliation: Cardiovascular Division, Minneapolis Heart Institute, Minneapolis, Minnesota.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Harris
authors.affiliation: Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Kevin
authors.initials: K
authors.lastname: Greason
authors.affiliation: Cardiac Surgery Department, University Hospital S. Orsola, Bologna, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Di Eusanio
authors.affiliation: Cardiology Division, University of Salerno, Salerno, Italy.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Montgomery
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.affiliation: Department of Internal Medicine, University of Rostock, Rostock, Germany.
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
authors.affiliation: Thoracic Aortic Center, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Isselbacher
authors.affiliation: Department of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Patrick
authors.initials: P
authors.lastname: O'Gara
mesh_terms: D000208:Acute Disease; 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; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012042:Registries; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: acute aortic dissection; management; outcomes