For this study, the researchers included 1,969 patients (mean age 61.1, 68.1% male) diagnosed with type A acute aortic dissection in IRAD between January 1996 and February 2012. Of those patients, 195 were managed medically, as opposed to receiving surgery.
The initial 24-hour mortality was higher for the medically managed group, compared with surgically managed patients, based on time from symptom onset (18.5% vs. 3.7%).
The mortality rate per hour during the initial 24 hours was 0.22% for all cases: 0.15% for surgically managed cases and 0.77% for medically managed cases. Among those patients managed medically, the rationale against surgery included age (41.7%), co-morbid illness (64.8%), patient refusal (27.1%), or other (21.3%).
"Essentially, we learned that the mortality rate for medically treated patients with acute aortic dissection hasn't changed significantly in the past 60 years, despite improvements in pharmacological treatment with beta-blockers and major advancements in diagnostic imaging tools," says Strauss. CT imaging is the most common method of diagnosis.
"The take-home message from our findings is that mortality is still extremely high for these patients, which calls for rapid diagnosis and rapid intervention through surgery," adds Harris, who is also co-director of the Acute Aortic Dissection Program and director of the echocardiography laboratory at the Minneapolis Heart Institute at Abbott Northwestern Hospital in Minneapolis. "These patients should not be medically managed throughout the night, for instance. If they are an appropriate candidate for surgery, they should be treated immediately."
|Contact: Steve Goodyear|
Minneapolis Heart Institute Foundation