title: Diagnosis, management and mortality in acute aortic syndrome: results of the Spanish Registry of Acute Aortic Syndrome (RESA-II).
abstract: BACKGROUND
  Recent advances in the diagnosis and treatment of acute aortic syndrome should improve the outcome of this disease. The Spanish Registry of Acute Aortic Syndrome aimed to assess current results in acute aortic syndrome management in a wide cohort of hospitals in the same geographical area.
  
  
  METHODS
  From January 2012 to January 2014, 26 tertiary hospitals included 629 consecutive patients with acute aortic syndrome: 73% men, mean age 64.7±14 years (range 22-92), 443 type A (70.4%) and 186 type B (29.6%).
  
  
  RESULTS
  Time elapsed between symptom onset and diagnosis was <12 hours in 70.7% of cases and <24 hours in 84.0% (median 5 hours; 25th-75th percentiles, 2.7-15.5 hours). Computed tomography was the first diagnostic technique in 78% of patients and transthoracic echocardiography in 15%. Surgical treatment was indicated in 78.3% of type A acute aortic syndrome. The interval between diagnosis and surgery was 4.8 hours (quartile 1-3, 2.5-11.4 hours). Among the patients with type B acute aortic syndrome, treatment was medical in 116 cases (62.4%), endovascular in 61 (32.8%) and surgical in nine (4.8%). Type A mortality during hospitalisation was 25.1% in patients treated surgically and 68% in those treated medically. Mortality in type B was 13.8% in those with medical treatment, 18.0% with endovascular therapy and 33.0% with surgical treatment.
  
  
  CONCLUSIONS
  Improvements in the diagnosis and treatment of acute aortic syndrome have not resulted in a significant reduction in hospital mortality. The results of this study reflect more overall and less selected information on acute aortic syndrome management and the need for sustained advances in the therapeutic strategy of acute aortic syndrome.
authors.affiliation: 1 Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Arturo
authors.initials: A
authors.lastname: Evangelista
authors.affiliation: 2 Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Rabasa
authors.affiliation: 3 Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain.
authors.forename: Victor X
authors.initials: VX
authors.lastname: Mosquera
authors.affiliation: 4 Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Barros
authors.affiliation: 5 Hospital Universitario Son Espases, Palma de Mallorca, Spain.
authors.forename: Ruben
authors.initials: R
authors.lastname: Fernández-Tarrio
authors.affiliation: 6 Complexo Hospitalario Universitario de Vigo, Vigo, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Calvo-Iglesias
authors.affiliation: 7 Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Ferrera
authors.affiliation: 8 Hospital Universitario de Asturias, Oviedo, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Rozado
authors.affiliation: 9 Hospital Germán Trias i Pujol, Badalona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: López-Ayerbe
authors.affiliation: 10 Hospital Universitario de León, León, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Garrote
authors.affiliation: 11 Hospital Clínico de Valladolid, Valladolid, Spain.
authors.forename: Jose-Alberto
authors.initials: JA
authors.lastname: San Román
authors.affiliation: 12 Hospital de Valdecilla, Universidad de Cantabria, Santander, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Nistal
authors.affiliation: 13 Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Violeta
authors.initials: V
authors.lastname: Sanchez
authors.affiliation: 14 Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Jose-Antonio
authors.initials: JA
authors.lastname: García Robles
authors.affiliation: 15 Hospital Universitario la Fe, Valencia, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Valera
authors.affiliation: 16 Hospital Miguel Servet, Zaragoza, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Ballester
authors.affiliation: 17 Hospital General de Valencia, Valencia, Spain.
authors.forename: Oscar
authors.initials: O
authors.lastname: Gil-Albarova
authors.affiliation: 18 Hospital la Paz, Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Domínguez
authors.affiliation: 19 Hospital Regional Universitario de Málaga, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Vivancos
authors.affiliation: 20 Hospital Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Mateo-Martinez
authors.affiliation: 21 Hospital Virgen de la Macarena, Sevilla, Spain.
authors.forename: Pastora
authors.initials: P
authors.lastname: Gallego
authors.affiliation: 22 Hospital Virgen de las Nieves, Granada, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: González-Molina
authors.affiliation: 23 Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: Covadonga
authors.initials: C
authors.lastname: Fernández-Golfin
authors.affiliation: 24 Hospital Clinic, Barcelona, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Josa
authors.affiliation: 25 Hospital General de Alicante, Alicante, Spain.
authors.forename: Aquilino
authors.initials: A
authors.lastname: Hurlé
authors.affiliation: 26 Hospital de Galdakao, Galdakano, Spain.
authors.forename: Ibon
authors.initials: I
authors.lastname: Rodríguez-Sanchez
authors.affiliation: 1 Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Rodríguez-Palomares
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D015607:Stents; D015996:Survival Rate / Q000639:trends; D013577:Syndrome; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: Acute aortic syndrome; aortic dissection; cardiovascular surgery; endovascular treatment; intramural haematoma