Yamaguchi Tetsuo, Nakai Michikazu, Yano Takao, Matsuyama Masakazu, Yoshino Hideaki, Miyamoto Yoshihiro, Sumita Yoko, Matsuda Hitoshi, Inoue Yousuke, Okita Yutaka, Minatoya Kenji, Ueda Yuichi, Ogino Hitoshi
Department of Cardiovascular Center, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo 105-8470, Japan.
Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, 6-1, Kishibe-shinmachi, Suita city, Osaka 565-8565, Japan.
Eur Heart J Acute Cardiovasc Care. 2021 Oct 1;10(7):701-709. doi: 10.1093/ehjacc/zuab031.
The population-based incidence and outcomes of acute aortic dissection (AAD) are still unknown because some patients are already dead on arrival, and the accurate diagnosis of AAD is difficult due to the low autopsy rate. We performed a population-based review of all patients with AAD in a well-defined geographical area in Japan between 2016 and 2018.
Data of all patients with AAD at Miyazaki Prefectural Nobeoka Hospital (MPNH), which performs medical care for 120 000 residents, were collected retrospectively. The emergency medical service is dedicated to the transfer of all patients in this area to the MPNH. For all patients who were dead on arrival, the diagnosis of AAD was made by autopsy imaging (AI) using computed tomography. The age-adjusted incidence and mortality per 100 000 population were calculated using the Japanese population distribution model in 2015. The total incidence of AAD was 79 (type A: 64.5%, n = 51). Of those, 60.8% (31/51) of patients with type A and 21.4% (6/28) with type B were dead on arrival and diagnosed by AI. The 30-day mortality rates were 74.5% (38/51) in type A and 25.0% (7/28) in type B. The age-adjusted incidence and mortality of AAD per 100 000 inhabitants were 17.6 (type A: 11.3, type B: 6.2) and 9.9 (type A: 8.4, type B: 1.5), respectively.
The population-based survey of AAD showed that the age-adjusted incidence of AAD was two-fold higher than in previous reports, and the actual mortality rates were markedly higher due to the high incidence of dead-on-arrival.
基于人群的急性主动脉夹层（AAD）发病率及转归情况仍不清楚，因为部分患者送达时已死亡，且由于尸检率低，AAD的准确诊断存在困难。我们对2016年至2018年日本一个明确地理区域内所有AAD患者进行了基于人群的回顾性研究。
回顾性收集了为12万居民提供医疗服务的宫崎县延冈医院（MPNH）所有AAD患者的数据。该地区的紧急医疗服务专门负责将所有患者转运至MPNH。对于所有送达时已死亡的患者，通过计算机断层扫描尸检成像（AI）进行AAD诊断。使用2015年日本人口分布模型计算每10万人口的年龄调整发病率和死亡率。AAD的总发病率为79例（A型：64.5%，n = 51）。其中，A型患者中有60.8%（31/51）和B型患者中有21.4%（6/28）送达时已死亡并通过AI诊断。A型患者的30天死亡率为74.5%（38/51），B型患者为25.0%（7/28）。每10万居民中AAD的年龄调整发病率和死亡率分别为17.6（A型：11.3，B型：6.2）和9.9（A型：8.4，B型：1.5）。
基于人群的AAD调查显示，AAD的年龄调整发病率比既往报告高出两倍，且由于送达时已死亡的发生率高，实际死亡率显著更高。
