Tzikas S, Loufopoulos G, Evangeliou A P, Boulmpou A, Fragakis N, Vassilikos V
Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Greece.
Hippokratia. 2021 Jan-Mar;25(1):42-46.
Acute aortic dissection (AAD) is a life-threatening condition with high mortality rates, despite significant advances in surgical approaches. The understanding of the clinical presentation and outcomes is crucial in order to upgrade management strategies. However, epidemiological data regarding AAD occurrence are scarce in Europe, highlighting the gap of evidence in the existing guidelines.
We investigated 197 consecutive patients admitted to our institution from January 2018 to December 2019 with suspicion of type A AAD, conducting a retrospective case series. All demographic characteristics, as well as the outcomes of these patients, were recorded and further analyzed to deliver data on the epidemiology of AAD. A total of 197 patients were admitted to our hospital with a suspected AAD. Forty-one (25.9 %) patients presented with a dilated aortic lumen or with a previously repaired aortic dissection, while 28 patients (14.2 %) were diagnosed with AAD (14 patients with type A AAD, 13 with type B AAD and 1 with intramural hematoma). Among 14 patients with type A AAD, nine patients (64.0 %) were treated surgically, while the rest were managed conservatively due to futile clinical status or inability for immediate transportation to a surgical facility. The most frequent initial symptom was chest pain in 86.0 % of patients, followed by dyspnea in 42.9 %. Post-surgical mortality was 33.0 %, while all patients that were managed conservatively did not survive. D-dimers on arrival were significantly lower among patients who survived compared to those who did not.
The incidence of type A AAD in our case series was consistent with the one demonstrated in other international cohorts; however, the mortality in our patient group was higher. Our results encourage surgical treatment due to a lower in-hospital mortality rate when compared to conservative treatment. HIPPOKRATIA 2021, 25 (1):42-46.
急性主动脉夹层（AAD）是一种危及生命的疾病，死亡率很高，尽管手术方法有了显著进展。了解临床表现和预后对于升级管理策略至关重要。然而，欧洲关于AAD发病情况的流行病学数据稀缺，凸显了现有指南中的证据空白。
我们对2018年1月至2019年12月期间因疑似A型AAD入住我院的197例连续患者进行了回顾性病例系列研究。记录了所有患者的人口统计学特征以及这些患者的预后情况，并进行进一步分析以提供AAD的流行病学数据。共有197例疑似AAD患者入住我院。41例（25.9%）患者表现为主动脉腔扩张或既往有主动脉夹层修复史，28例（14.2%）患者被诊断为AAD（14例A型AAD、13例B型AAD和1例壁内血肿）。在14例A型AAD患者中，9例（64.0%）接受了手术治疗，其余患者因临床状况不佳或无法立即转运至手术机构而接受保守治疗。最常见的初始症状是86.0%的患者出现胸痛，其次是42.9%的患者出现呼吸困难。术后死亡率为33.0%，而所有接受保守治疗的患者均未存活。与未存活患者相比，存活患者入院时的D - 二聚体水平显著更低。
我们病例系列中A型AAD的发病率与其他国际队列研究显示的发病率一致；然而，我们患者组的死亡率更高。与保守治疗相比，我们的结果表明手术治疗因住院死亡率较低而值得提倡。《希波克拉底》2021年，25（1）：42 - 46。
