Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Rev Esp Cardiol (Engl Ed). 2022 Oct;75(10):816-824. doi: 10.1016/j.rec.2022.01.017. Epub 2022 May 5.
The Spanish Registry of Acute Aortic Syndrome (RESA) was launched in 2005 to identify the characteristics of acute aortic syndrome (AAS) in Spain. The aim of this study was to analyze the differences in management and mortality in the 3 RESA iterations.
We analyzed data from patients with AAS prospectively included by 24 to 30 tertiary centers during the 3 iterations of the registry: RESA I (2005-2006), RESA-II (2012-2013), and RESA III (2018-2019).
AAS was diagnosed in 1902 patients (74% men; age, 60.7±12.5 years): 1329 (69.9%) type A and 573 (30.1%) type B. Comparison of the 3 periods revealed that the use of computed tomography increased as the first diagnostic technique (77.1%, 77.9%, and 84.2%, respectively; P=.001). In type A, surgical management increased (79.6%, 78.7%, and 84.5%; P=.045) and overall mortality decreased (41.2%, 34.5%, and 31.2%; P=.002), due to a reduction in surgical mortality (33.4%, 25.1%, and 23.9%; P=.003). In type B, endovascular treatment increased (22.8%, 32.8%, and 38.7%; P=.006), while medical and surgical treatment decreased. Overall type B mortality also decreased (21.6%, 16.1%, and 12.0%; P=.005) in line with a reduction in mortality with medical (16.8%, 13.8%, and 8.8%, P=.030) and endovascular (27.0%, 18.0%, and 9.2%; P=.009) treatments.
The iterations of RESA show a decrease in mortality from type A AAS, coinciding with an increase in surgical treatment and a reduction in surgical mortality. In type B, the use of endovascular treatment was associated with improved survival, allowing better management in patients with complications.
西班牙急性主动脉综合征注册研究（RESA）于 2005 年启动，旨在明确西班牙急性主动脉综合征（AAS）的特征。本研究旨在分析该注册研究 3 个迭代版本中治疗和死亡率的差异。
我们前瞻性分析了 24 至 30 家三级中心在注册研究的 3 个迭代版本中纳入的 AAS 患者的数据：RESA I（2005-2006 年）、RESA II（2012-2013 年）和 RESA III（2018-2019 年）。
共诊断 1902 例 AAS 患者（74%为男性；年龄 60.7±12.5 岁）：1329 例（69.9%）为 A 型，573 例（30.1%）为 B 型。3 个时期的比较显示，计算机断层扫描作为首选诊断技术的应用比例逐渐增加（分别为 77.1%、77.9%和 84.2%；P=.001）。在 A 型中，手术治疗比例增加（分别为 79.6%、78.7%和 84.5%；P=.045），整体死亡率降低（分别为 41.2%、34.5%和 31.2%；P=.002），这主要归因于手术死亡率的降低（分别为 33.4%、25.1%和 23.9%；P=.003）。在 B 型中，血管内治疗的应用比例增加（分别为 22.8%、32.8%和 38.7%；P=.006），而药物和手术治疗的应用比例减少。B 型的整体死亡率也下降（分别为 21.6%、16.1%和 12.0%；P=.005），这与药物（分别为 16.8%、13.8%和 8.8%，P=.030）和血管内（分别为 27.0%、18.0%和 9.2%；P=.009）治疗死亡率的降低一致。
RESA 的迭代版本显示 A 型 AAS 的死亡率降低，这与手术治疗的增加和手术死亡率的降低有关。在 B 型中，血管内治疗的应用与生存率的提高相关，允许对伴有并发症的患者进行更好的治疗。
