CLINICAL STUDY: AORTIC DISSECTION
Acute type A aortic dissection in the elderly: clinical characteristics, management, and outcomes in the current era
Rajendra H. Mehta, MD, FACC, MS*,*,
Patrick T. O’Gara, MD, FACC ,
Eduardo Bossone, MD ,
Christoph A. Nienaber, MD, FACC ,
Truls Myrmel, MD||,
Jeanna V. Cooper, MS*,
Dean E. Smith, PhD*,
William F. Armstrong, MD, FACC*,
Eric M. Isselbacher, MD, FACC¶,
Linda A. Pape, MD, FACC#,
Kim A. Eagle, MD, FACC*,
Dan Gilon, MD, FACC** on behalf of the International Registry of Acute Aortic Dissection (IRAD) Investigators
* University of Michigan, Ann Arbor, Michigan, USA
Brigham and Women’s Hospital, Boston, Massachusetts, USA
Istituto Policlinico San Donato, San Donato, Italy
University of Rostock, Rostock, Germany
|| Tromsø University Hospital, Tromsø, Norway
¶ Massachusetts General Hospital, Boston, Massachusetts, USA
# University of Massachusetts Hospital, Worcester, Massachusetts, USA
** Hadassah University Hospital, Jerusalem, Israel
Manuscript received August 21, 2001;
revised manuscript received April 25, 2002,
accepted May 16, 2002.
* Reprint requests and correspondence: Dr. Rajendra H. Mehta, Clinical Assistant Professor of Internal Medicine, University of Michigan, Cardiology 111A 7E, 2215 Fuller Road, Ann Arbor, Michigan 48105, USA.
rmehta{at}umich.edu
OBJECTIVES: We sought to evaluate the clinical characteristics, management, and outcomes of elderly patients with acute type A aortic dissection.
BACKGROUND: Few data exist on the clinical manifestations and outcomes of acute type A aortic dissection in an elderly patient cohort.
METHODS: We categorized 550 patients with type A aortic dissection enrolled in the International Registry of Acute Aortic Dissection into two age strata (<70 and  70 years) and compared their clinical features, management, and in-hospital events.
RESULTS: Thirty-two percent of patients with type A dissection were aged 70 years. Marfan syndrome was exclusively associated with dissection in the young, whereas hypertension, atherosclerosis and iatrogenic dissection predominated in older patients. Typical symptoms (abrupt onset of chest or back pain) and signs (aortic regurgitation murmur or pulse deficits) of dissection were less common among the elderly. Fewer elderly patients were managed surgically than younger patients (64% vs. 86%, p < 0.0001). Hypotension occurred more frequently (46% vs. 32%, p = 0.002) and focal neurologic deficits less frequently (18% vs. 26%, p = 0.04) among the elderly. In-hospital mortality was higher among older patients (43% vs. 28%, p = 0.0006). Logistic regression analysis identified age 70 years as an independent predictor of hospital death for acute type A aortic dissection (odds ratio 1.7, 95% confidence interval 1.1–2.8; p = 0.03).
CONCLUSIONS: Our study shows significant differences between older (age 70 years) and younger (age <70 years) patients with acute type A aortic dissection in their clinical characteristics, management, and hospital outcomes. Future research should evaluate strategies to improve outcomes in this high-risk elderly cohort.
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Abbreviations and Acronyms
| | IRAD | | International Registry of Acute Aortic Dissection |
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|
|
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|
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|
|
|
|
|
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|
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|
|
|
|
|
|
|
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43(4):
665 - 669.
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[Full Text]
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|
|
|
|
|
|
|
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August 12, 2003;
108(6):
772 - 778.
[Full Text]
[PDF]
|
|
|
|
|
|
|
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108(5):
628 - 635.
[Full Text]
[PDF]
|
|
|
|
