Document Detail


Geographic differences in clinical presentation, treatment, and outcomes in type A acute aortic dissection (from the International Registry of Acute Aortic Dissection).
MedLine Citation:
PMID:  19026315     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Although several studies have provided robust evidence about global differences for several cardiovascular emergencies, such as myocardial infarction and stroke, data were limited for aortic disease. The aim was to explore geographic variation in type A acute aortic dissection (TA-AAD) in a large group of consecutive patients. Patients (n = 615) from the IRAD with TA-AAD were studied with respect to presenting symptoms and signs, diagnosis, management, and outcomes in Europe versus North America. Compared with Europeans, North Americans were more likely to be older and present with atypical features and without many of the classic chest X-ray findings of AAD. In the North American cohort, electrocardiographic findings showed higher rates of nonspecific ST changes and a trend toward ST-elevation or new myocardial infarction (North Americans vs Europeans 7.9% vs 4.4%; p = 0.09). Use of imaging studies to confirm the diagnosis of AAD varied between North American and European centers. North American centers performed an average of 1.6 imaging studies compared with 1.8 in the European group (p = 0.002). Furthermore, they were significantly less likely to use computed tomography and significantly more likely to use transesophageal examination as part of the overall diagnostic algorithm. Compared with Europeans, TA-AAD occurred at smaller aortic diameters and there was a substantial delay to presentation and diagnosis in North Americans. No significant differences for early mortality rates were observed between the 2 groups. In conclusion, geographic differences in presentation and initial management were highlighted, but this did not translate into a difference in early mortality.
Authors:
Arun Raghupathy; Christoph A Nienaber; Kevin M Harris; Truls Myrmel; Rossella Fattori; Udo Sechtem; Jae Oh; Santi Trimarchi; Jeanna V Cooper; Anna Booher; Kim Eagle; Eric Isselbacher; Eduardo Bossone;
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-09-12
Journal Detail:
Title:  The American journal of cardiology     Volume:  102     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-11-25     Completed Date:  2008-12-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1562-6     Citation Subset:  AIM; IM    
Affiliation:
University of Michigan, Ann Arbor, MI, USA.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adult
Aged
Aneurysm, Dissecting / diagnosis*,  drug therapy*,  epidemiology,  surgery
Aortic Rupture / diagnosis*,  drug therapy*,  epidemiology,  surgery
Europe / epidemiology
Female
Health Status Indicators
Humans
Male
Middle Aged
Registries
Treatment Outcome
United States / epidemiology
Young Adult
Investigator
Investigator/Affiliation:
Kim A Eagle / ; Eric M Isselbacher / ; Christoph A Nienaber / ; Eduardo Bossone / ; Alan Braverman / ; Stefanos Demertzis / ; Giuseppe DiBenedetto / ; Mark Ehrlich / ; Arturo Evangelista / ; Rossella Fattori / ; James Froehlich / ; Thomas Tsai / ; Dan Gilon / ; Alan Hirsch / ; Kevin Harris / ; G Chad Hughes / ; Stuart Hutchison / ; James L Januzzi / ; Alfredo Llovet / ; Truls Myrmel / ; Peter Oberwalder / ; Patrick O'Gara / ; Joshua Beckman / ; Jae K Oh / ; Linda A Pape / ; Reed Pyeritz / ; Udo Sechtem / ; Gabriel Meinhardt / ; Robert-Bosch Krankenhaus / ; P Gabriel Steg / ; Toru Suzuki / ; Santi Trimarchi / ; Jeanna V Cooper / ; Dean E Smith / ; Elise Woznicki /

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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