Changes in the diagnosis and management of acute aortic syndrome and associated mortality in the last 20 years

Rev Esp Cardiol (Engl Ed) . 2021 Mar;74(3):257-262. doi: 10.1016/j.rec.2020.02.015. Epub 2020 Jun 1.

Fecha de la publicación: 01/06/2020

Autor: Arturo Evangelista (1), José A Barrabés (2), Rosa-María Lidón (2), Rafael Rodríguez-Lecoq (3), Jordi Maeso (4), Sergi Bellmunt (4), Ángela López-Sainz (2), Carlos Sureda (3), Gisela Teixidó-Tura (2), Teresa González-Alujas (2), Hug Cuellar (5), Augusto Sao-Aviles (2), David García-Dorado (2), Ignacio Ferreira-González (6), José Rodríguez-Palomares (2)

Palabras clave: Acute aortic syndrome, Aortic dissection, Aortic surgery, Cirugía de aorta, Disección de aorta, Endovascular treatment, Imaging techniques, Prognosis, Pronóstico, Síndrome aórtico agudo, Técnicas de imagen, Tratamiento endovascular

PMID

PMID: 32499017
DOI: 10.1016/j.rec.2020.02.015

Affiliations

¹Servicio de Cardiología, Hospital Universitari Vall d’Hebron, Institut de Recerca Vall d’Hebron (VHIR), Barcelona, CIBER-CV, Spain. Electronic address: arturevangelistamasip@gmail.com.

²Servicio de Cardiología, Hospital Universitari Vall d’Hebron, Institut de Recerca Vall d’Hebron (VHIR), Barcelona, CIBER-CV, Spain.

³Servicio de Cirugía Cardiaca, Hospital Universitari Vall d’Hebron, Barcelona, Spain.

⁴Servicio de Cirugía Vascular, Hospital Universitari Vall d’Hebron, Barcelona, Spain.

⁵Servicio de Radiología, IDI, Hospital Universitari Vall d’Hebron, Barcelona, Spain.

⁶Servicio de Cardiología, Hospital Universitari Vall d’Hebron, Institut de Recerca Vall d’Hebron (VHIR), Barcelona, CIBER-CV, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain.

Abstract

Introduction and objectives: Mortality is high in acute aortic syndrome (AAS), which therefore requires early treatment. This study aimed to analyze changes in the diagnosis and treatment of AAS over 20 years at our center.

Methods: From 1999 to 2018, 451 patients diagnosed with AAS (336 men; mean age, 60.9±12.4 years) were prospectively included (270 type A and 181 type B). Clinical variables, diagnosis, treatment, and in-hospital complications were analyzed.

Results: The use of computed tomography (CT) as the first-line diagnostic technique increased from 62.8% to 94.2% (P <.001). Surgical treatment of type A AAS rose from 67.4% to 82.5% (P=.09). Mortality from type A AAS decreased significantly from 53.1% to 26.3% (P <.001) as a result of the fall in mortality from surgical treatment (from 45.4% to 17.0%; P <.001). The use of medical treatment alone for type B AAS decreased from 91.8% to 61.7% (P <.001) due to the greater use of endovascular treatment. Mortality from type B AAS showed no significant reduction (16.2% to 10.6%; P=.15).

Conclusions: The diagnosis and treatment of AAS has changed substantially in the last 2 decades. CT has become the first-line diagnostic technique for AAS. In type A AAS, mortality has fallen significantly due to improvements in the results of surgical treatment. In type B AAS, the use of medical treatment alone has decreased due to the expansion of endovascular treatment, although in-hospital mortality has not decreased significantly.