TY - JOUR
T1 - Clinical Characteristics, Incidences, and Mortality Rates for Type A and B Aortic Dissections
T2 - A Nationwide Danish Population-Based Cohort Study From 1996 to 2016
AU - Obel, Lasse M.
AU - Lindholt, Jes S.
AU - Lasota, Anne N.
AU - Jensen, Henrik K.
AU - Benhassen, Leila L.
AU - Mørkved, Amalie L.
AU - Srinanthalogen, Reshaabi
AU - Christiansen, Malina
AU - Bundgaard, Henning
AU - Liisberg, Mads
PY - 2022/12/20
Y1 - 2022/12/20
N2 - BACKGROUND: Population-based epidemiologic studies of aortic dissections (ADs) are needed. This study aimed to report clinical characteristics, incidences, and mortality rates for adult patients admitted to Danish hospitals with type A AD (TAAD) or type B AD (TBAD) from 1996 through 2016.METHODS: We conducted a nationwide, population-based register study. All cases of AD registered with
International Classification of Diseases, Tenth Revision codes in the Danish National Patient Registry at time of admission to a hospital with available medical records underwent validation. Data were merged between nationwide health registries including the cause of death registry. Patients with validated AD were matched 1:10 on sex and age with patients with hypertension from the general Danish population.
RESULTS: Of 5018 registered cases of AD, 4183 cases underwent review and 3023 (60.2%) were validated as AD. After exclusions, the distribution of validated TAAD and TBAD was 1620 (60.5%) and 1059 (39.5%;
P<0.001), 67.5% and 67.0% of patients were men, and mean ages at dissection were 63.5±12.9 and 67.5±12.2 years (
P<0.001), respectively. The most prevalent comorbidities for TAAD were hypertension (55.2%), thoracic aortic aneurysms (14.6%), and chronic obstructive pulmonary disease (13.1%); for TBAD, the most prevalent comorbidities were hypertension (64.1%), aortic aneurysms at any location (7.5% to 12.0%), and chronic obstructive pulmonary disease (15.7%). The overall mean annual incidence rate was 4.2/100 000 patient-years. Incidence was significantly higher for TAAD (2.2/100 000) compared with TBAD (1.5/100 000;
P<0.001). The 30-day mortality rates for validated TAAD and TBAD were 22.0% and 13.9% (
P<0.001), respectively, with no significant changes over time or between sexes. Adjusted 5-year overall mortality rates for TAAD and TBAD were hazard ratio 3.2 (2.9 to 3.5;
P<0.001; aortic-related cause of death, 57.0%) and hazard ratio 2.1 (1.9 to 2.4;
P<0.001; aortic-related cause of death, 42.8%), respectively, compared with the general hypertensive population. Among patients who survived 30 days from dissection, the adjusted 5-year overall mortality rates were hazard ratio 1.1 (1.0 to 1.3;
P=0.12; aortic-related cause of death, 23.2%) and hazard ratio 1.4 (1.2 to 1.6;
P<0.001; aortic-related cause of death, 25.6%) for TAAD and TBAD, respectively.
CONCLUSIONS: Hypertension, aortic aneurysms, and chronic obstructive pulmonary disease were the most prevalent comorbidities. The 30-day mortality frequencies were consistent over time with no significant differences between sexes. The 5-year mortality rate was higher for TAAD than TBAD. If the patient survived 30 days from dissection, the mortality rate for patients with TAAD was comparable with that of the general hypertensive population, but the mortality rate was significantly higher in patients with TBAD.
AB - BACKGROUND: Population-based epidemiologic studies of aortic dissections (ADs) are needed. This study aimed to report clinical characteristics, incidences, and mortality rates for adult patients admitted to Danish hospitals with type A AD (TAAD) or type B AD (TBAD) from 1996 through 2016.METHODS: We conducted a nationwide, population-based register study. All cases of AD registered with
International Classification of Diseases, Tenth Revision codes in the Danish National Patient Registry at time of admission to a hospital with available medical records underwent validation. Data were merged between nationwide health registries including the cause of death registry. Patients with validated AD were matched 1:10 on sex and age with patients with hypertension from the general Danish population.
RESULTS: Of 5018 registered cases of AD, 4183 cases underwent review and 3023 (60.2%) were validated as AD. After exclusions, the distribution of validated TAAD and TBAD was 1620 (60.5%) and 1059 (39.5%;
P<0.001), 67.5% and 67.0% of patients were men, and mean ages at dissection were 63.5±12.9 and 67.5±12.2 years (
P<0.001), respectively. The most prevalent comorbidities for TAAD were hypertension (55.2%), thoracic aortic aneurysms (14.6%), and chronic obstructive pulmonary disease (13.1%); for TBAD, the most prevalent comorbidities were hypertension (64.1%), aortic aneurysms at any location (7.5% to 12.0%), and chronic obstructive pulmonary disease (15.7%). The overall mean annual incidence rate was 4.2/100 000 patient-years. Incidence was significantly higher for TAAD (2.2/100 000) compared with TBAD (1.5/100 000;
P<0.001). The 30-day mortality rates for validated TAAD and TBAD were 22.0% and 13.9% (
P<0.001), respectively, with no significant changes over time or between sexes. Adjusted 5-year overall mortality rates for TAAD and TBAD were hazard ratio 3.2 (2.9 to 3.5;
P<0.001; aortic-related cause of death, 57.0%) and hazard ratio 2.1 (1.9 to 2.4;
P<0.001; aortic-related cause of death, 42.8%), respectively, compared with the general hypertensive population. Among patients who survived 30 days from dissection, the adjusted 5-year overall mortality rates were hazard ratio 1.1 (1.0 to 1.3;
P=0.12; aortic-related cause of death, 23.2%) and hazard ratio 1.4 (1.2 to 1.6;
P<0.001; aortic-related cause of death, 25.6%) for TAAD and TBAD, respectively.
CONCLUSIONS: Hypertension, aortic aneurysms, and chronic obstructive pulmonary disease were the most prevalent comorbidities. The 30-day mortality frequencies were consistent over time with no significant differences between sexes. The 5-year mortality rate was higher for TAAD than TBAD. If the patient survived 30 days from dissection, the mortality rate for patients with TAAD was comparable with that of the general hypertensive population, but the mortality rate was significantly higher in patients with TBAD.
KW - Adult
KW - Aortic Aneurysm, Thoracic
KW - Aortic Aneurysm/etiology
KW - Aortic Dissection
KW - Cohort Studies
KW - Denmark
KW - Endovascular Procedures/adverse effects
KW - Female
KW - Humans
KW - Hypertension/etiology
KW - Incidence
KW - Male
KW - Pulmonary Disease, Chronic Obstructive
KW - Retrospective Studies
KW - Risk Factors
KW - Treatment Outcome
KW - aneurysm, dissecting
KW - epidemiology
KW - mortality
KW - incidence
UR - http://www.scopus.com/inward/record.url?scp=85144588977&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.122.061065
DO - 10.1161/CIRCULATIONAHA.122.061065
M3 - Journal article
C2 - 36321467
SN - 0009-7322
VL - 146
SP - 1903
EP - 1917
JO - Circulation
JF - Circulation
IS - 25
ER -