title: The sharp end of cardiovascular disease in New Zealand: A review of acute type A aortic dissections of the Waikato.
abstract: OBJECTIVE
  Acute type A aortic dissections are lethal cardiovascular surgical emergencies. This study is a retrospective comparative review of mortality in Type A aortic dissections between Māori and non-Māori populations of the Midland DHBs catchment area.
  
  
  METHODS
  143 patients identified with diagnosis of type A aortic dissections at Waikato Hospital from 1990 to 2013, as identified in Waikato Hospital clinical records and cardiothoracic surgery database. The Māori and non-Māori populations were compared according to demographics, 30-day survival and 5-year survival.
  
  
  RESULTS
  The overall 30-day mortality rate of 28% was consistent with published international data, but there were significant ethnic and gender disparities related to the high prevalence of cardiovascular risk factors, particularly in the Māori population. Māori have a significantly higher prevalence of type A aortic dissections (2.5 per 10,000) compared to non-Māori (1.4 per 10,000) and have a 5-year earlier mean age at presentation compared to non-Māori. Māori females have the highest mortality rates with almost half succumbing within 30 days of surgery (45.5%).
  
  
  CONCLUSIONS
  The future promises an increasing incidence of acute type A aortic dissections in a younger Māori population with severe disease burden and less reserve, as well as in an elderly population where age is an independent predictor of worse operative mortality, morbidity and reduced long-term survival. GP and specialist collaborative directions are identified towards evolution of surgery and systems to maintain, if not improve, early and late survival rates in the Midland DHBs catchment region.
authors.forename: Anshuman
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Cardiothoracic Surgeon, PO Box 3535, Manuka ACT 2603, Australia. subramaniam.peter@gmail.com.
authors.forename: Peter
authors.initials: P
authors.lastname: Subramaniam
authors.forename: Peter
authors.initials: P
authors.lastname: Subramaniam
authors.forename: Katherine
authors.initials: K
authors.lastname: Hulme
mesh_terms: D017677:Age Distribution; D000368:Aged; D001019:Aortic Rupture / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality / Q000601:surgery; D042241:Early Diagnosis; D061345:Early Medical Intervention; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009520:New Zealand / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D016019:Survival Analysis; D014656:Vascular Surgical Procedures / Q000401:mortality