Chest
Volume 117, Issue 5, May 2000, Pages 1271-1278
Journal home page for Chest

Clinical Investigations
SURGERY
Epidemiology and Clinicopathology of Aortic Dissection

https://doi.org/10.1378/chest.117.5.1271Get rights and content

Study objectives

To determine the incidence and mortality as well as to analyze the clinical and pathologic changes of aortic dissection.

Design and setting

A population-based longitudinal study over 27 years on a study population of 106,500, including 66 hospitalized and 18 nonhospitalized consecutively observed patients.

Measures

Analysis of data from the medical, surgical, and autopsy records of patients with aortic dissection.

Results

Altogether, 86 cases of aortic dissection were found in 84 patients, corresponding to a 2.9/100,000/yr incidence. Sixty-six of the 84 patients (79%) were admitted to the hospital, and 18 patients (21%) died before admission. Their ages ranged from 36 to 97 years, with a mean of 65.7 years. The male/female ratio was 1.55 to 1. A total of 22.7% of the hospitalized patients died within the first 6 h, 33.3% within 12 h, 50% within 24 h, and 68.2% within the first 2 days after admission. Six patients were operated on, with a perioperative mortality of two of six patients and a 5-year survival of two of six patients. All patients who were not operated on died. Pain was the most frequent initial symptom. Every patient had some kind of cardiovascular and respiratory sign. Neurologic symptoms occurred in 28 of 66 patients (42%). Five patients presented with clinical pictures of acute abdomen and two with acute renal failure. Trunk arteries were affected in 33 of the 80 autopsied cases (41%), and rupture of aorta was seen in 69 cases (86%). In five cases, spontaneous healing of dissection was also found. The ratio of proximal/distal dissections was 5.1 to 1. All 18 prehospital cases were acute. Fifty-nine cases (89.4%) were acute at admission, and 7 cases (10.6%) were chronic dissections. Hypertension and advanced age were the major predisposing factors.

Conclusion

Aortic dissection was the initial clinical impression in only 13 of the 84 patients (15%). Thus, 85% of the patients did not receive immediate appropriate medical treatment. For this reason, these late-recognized and/or unrecognized cases may be regarded as an untreated or symptomatically treated group, whose course may resemble the natural course of aortic dissection.

Section snippets

Materials and Methods

The geographic area of this study included three adjacent small towns in western Hungary: Sümeg, Tapolca, and Keszthely, and their immediate environs, comprising a fairly stable population about 106,500 in the time frame of January 1, 1972, to December 31, 1998. This longitudinal study includes both the hospitalized and the nonhospitalized cases within the population found in the observed time interval.

All admissions were to the internal medicine department of the respective hospitals, with the

Incidence and Mortality

The finding of 86 cases of aortic dissection originated from 84 patients in this population of 106,500 followed for 27 years (total of 2,875,000 person-years of observation) indicates an incidence of 2.9/100,000/yr. Two of the six patients who underwent operation died either during or following the operation. One patient died of redissection 34 days after the operation, and another patient died 38 months after the operation from nonoperation-related acute myocardial infarction. Two patients are

Incidence and Mortality

In contrast with the generally accepted and cited incidence of 0.5 to 1.0/100,000/yr of aortic dissection,7, 1415 it was found to be 2.95/100,000/yr in this well-defined study population, in agreement with some studies pursued on defined populations. The incidence of aortic dissection in Memphis, TN, was estimated about 2.0/100,000/yr.16 It was 2.7/100,000/yr in Rochester, MN, between 1951 and 1980,17 and 4.04/100,000/yr in the Treviso area of Italy between 1976 and 1988.8 In the United States

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