CLINICAL RESEARCH
Characterizing the young patient with aortic dissection: results from the international registry of aortic dissection (IRAD)
James L. Januzzi, MD, FACC*,
Eric M. Isselbacher, MD, FACC*,
Rossella Fattori, MD, FACC ,
Jeanna V. Cooper, MS ,
Dean E. Smith, PhD,
Jianming Fang, MD,
Kim A. Eagle, MD, FACC,
Rajendra H. Mehta, MD, FACC,
Christoph A. Nienaber, MD, FACC and
Linda A. Pape, MD, FACC||,*
* Thoracic Aorta Center and Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
University Hospital S. Orsola, Bologna, Italy
Cardiology Division and Coordinating Center for the IRAD Investigators, University of Michigan Medical Center, Ann Arbor, Michigan, USA
Cardiology Division, University of Rostock, Rostock, Germany
|| Cardiology Division, University of Massachusetts Medical School, Worcester, Massachusetts, USA
Manuscript received January 24, 2003;
revised manuscript received July 17, 2003,
accepted August 11, 2003.
* Reprint requests and correspondence: Dr. Linda A. Pape, University of Massachusetts Medical School, 55 Lake Avenue North, S3-850, Worcester, Massachusetts 01655, USA.
Linda.pape{at}umassmed.edu
OBJECTIVES: The goal of this study was to better characterize the young patient with aortic dissection (AoD).
BACKGROUND: Aortic dissection is unusual in young patients, and frequently associated with unusual presentations.
METHODS: Data were collected on 951 patients diagnosed with AoD between January 1996 and November 2001. Two categories of patients, <40 years and  40 years, were compared using chi-square cross tabulations for categorical and Student t test for continuous data.
RESULTS: Sixty-eight patients (7%) with AoD were <40 years of age. Compared with patients 40 years, younger patients were less likely to have a prior history of hypertension (p < 0.05); however, younger patients were more likely to have Marfan syndrome, bicuspid aortic valve, and prior aortic surgery (all, p < 0.05). Clinical presentations in the two age groups were similar; however, younger patients were less likely to be hypertensive (25% vs. 45%, p = 0.003). The proximal aortas of young AoD patients were larger (all, p < 0.05) compared with older patients. These differences in aortic size between age groups were not entirely related to Marfan syndrome. Mortality among young patients was similar to patients 40 years of age (22% vs. 24%, p = NS), irrespective of the site of dissection.
CONCLUSIONS: Compared with older patients with AoD, young patients have unique risk factors for dissection: Marfan syndrome, bicuspid aortic valves, and larger aortic dimensions. Surprisingly, the mortality risk for young AoD patients is not lower than older AoD patients.
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Abbreviations and Acronyms
| | AoD | = aortic dissection | | BAV | = bicuspid aortic valve | | IRAD | = International Registry of Aortic Dissection |
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