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Eur Heart J Acute Cardiovasc Care. 2018 Oct;7(7):602-608. doi: 10.1177/2048872616682343. Epub 2016 Dec 28.

Diagnosis, management and mortality in acute aortic syndrome: results of the Spanish Registry of Acute Aortic Syndrome (RESA-II).

Author information

1
1 Hospital Vall d'Hebron, Barcelona, Spain.
2
2 Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain.
3
3 Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain.
4
4 Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
5
5 Hospital Universitario Son Espases, Palma de Mallorca, Spain.
6
6 Complexo Hospitalario Universitario de Vigo, Vigo, Spain.
7
7 Hospital Clínico San Carlos, Madrid, Spain.
8
8 Hospital Universitario de Asturias, Oviedo, Spain.
9
9 Hospital Germán Trias i Pujol, Badalona, Spain.
10
10 Hospital Universitario de León, León, Spain.
11
11 Hospital Clínico de Valladolid, Valladolid, Spain.
12
12 Hospital de Valdecilla, Universidad de Cantabria, Santander, Spain.
13
13 Hospital Universitario 12 de Octubre, Madrid, Spain.
14
14 Hospital General Universitario Gregorio Marañón, Madrid, Spain.
15
15 Hospital Universitario la Fe, Valencia, Spain.
16
16 Hospital Miguel Servet, Zaragoza, Spain.
17
17 Hospital General de Valencia, Valencia, Spain.
18
18 Hospital la Paz, Madrid, Spain.
19
19 Hospital Regional Universitario de Málaga, Spain.
20
20 Hospital Virgen de la Arrixaca, Murcia, Spain.
21
21 Hospital Virgen de la Macarena, Sevilla, Spain.
22
22 Hospital Virgen de las Nieves, Granada, Spain.
23
23 Hospital Ramón y Cajal, Madrid, Spain.
24
24 Hospital Clinic, Barcelona, Spain.
25
25 Hospital General de Alicante, Alicante, Spain.
26
26 Hospital de Galdakao, Galdakano, Spain.

Abstract

BACKGROUND:

Recent advances in the diagnosis and treatment of acute aortic syndrome should improve the outcome of this disease. The Spanish Registry of Acute Aortic Syndrome aimed to assess current results in acute aortic syndrome management in a wide cohort of hospitals in the same geographical area.

METHODS:

From January 2012 to January 2014, 26 tertiary hospitals included 629 consecutive patients with acute aortic syndrome: 73% men, mean age 64.7±14 years (range 22-92), 443 type A (70.4%) and 186 type B (29.6%).

RESULTS:

Time elapsed between symptom onset and diagnosis was <12 hours in 70.7% of cases and <24 hours in 84.0% (median 5 hours; 25th-75th percentiles, 2.7-15.5 hours). Computed tomography was the first diagnostic technique in 78% of patients and transthoracic echocardiography in 15%. Surgical treatment was indicated in 78.3% of type A acute aortic syndrome. The interval between diagnosis and surgery was 4.8 hours (quartile 1-3, 2.5-11.4 hours). Among the patients with type B acute aortic syndrome, treatment was medical in 116 cases (62.4%), endovascular in 61 (32.8%) and surgical in nine (4.8%). Type A mortality during hospitalisation was 25.1% in patients treated surgically and 68% in those treated medically. Mortality in type B was 13.8% in those with medical treatment, 18.0% with endovascular therapy and 33.0% with surgical treatment.

CONCLUSION:

Improvements in the diagnosis and treatment of acute aortic syndrome have not resulted in a significant reduction in hospital mortality. The results of this study reflect more overall and less selected information on acute aortic syndrome management and the need for sustained advances in the therapeutic strategy of acute aortic syndrome.

KEYWORDS:

Acute aortic syndrome; aortic dissection; cardiovascular surgery; endovascular treatment; intramural haematoma

PMID:
28029052
DOI:
10.1177/2048872616682343
[Indexed for MEDLINE]

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