Risikokonstellation bei akuter Aortendissektion - Bedeutung für die Therapie

Abstract

Acute aortic dissection is a life-threatening cardiovascular disease associated with high morbidity and mortality. Introduction of newer imaging modalities and therapeutic strategies have shown potential to improve diagnosis and management. The International Registry of Acute Aortic Dissection (IRAD) was established in 1996 to assess current-day profiles and outcomes of this medical emergency. Analysis from this on-going multinational database has contributed to a better understanding of clinical presentation and prognosis in patients with acute aortic dissection. Simple risk prediction tools are now available allowing accurate estimation of a patients in-hospital risk using readily available clinical information at time of presentation. Like for other cardiovascular diseases, such tools can be used for educating patients about their individual risk and in clinical research for risk adjustment while comparing outcomes of different therapeutic approaches. The present article summarizes the most striking insights from IRAD spanning more than 10 years of clinical research.

Literatur

• 1 Hagan P G, Nienaber C A, Isselbacher E M. et al . The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease.  Jama. 2000;  283 897-903
• 2 Mehta R H, Suzuki T, Hagan P G. et al . Predicting death in patients with acute type a aortic dissection.  Circulation. 2002;  105 200-206
• 3 Collins J S, Evangelista A, Nienaber C A. et al . Differences in clinical presentation, management, and outcomes of acute type a aortic dissection in patients with and without previous cardiac surgery.  Circulation. 2004;  110 II237-242
• 4 Bossone E, Rampoldi V, Nienaber C A. et al . Usefulness of pulse deficit to predict in-hospital complications and mortality in patients with acute type A aortic dissection.  Am J Cardiol. 2002;  89 851-855
• 5 Pape L A, Tsai T T, Isselbacher E M. et al . Aortic diameter > or = 5.5 cm is not a good predictor of type A aortic dissection: observations from the International Registry of Acute Aortic Dissection (IRAD).  Circulation. 2007;  116 1120-1127
• 6 Suzuki T, Mehta R H, Ince H. et al . Clinical profiles and outcomes of acute type B aortic dissection in the current era: lessons from the International Registry of Aortic Dissection (IRAD).  Circulation. 2003;  108 Suppl 1 II312-317
• 7 Tsai T T, Isselbacher E M, Trimarchi S. et al . Acute type B aortic dissection: does aortic arch involvement affect management and outcomes? Insights from the International Registry of Acute Aortic Dissection (IRAD).  Circulation. 2007;  116 I150-156
• 8 Nienaber C A, Fattori R, Mehta R H. et al . Gender-related differences in acute aortic dissection.  Circulation. 2004;  109 3014-3021
• 9 Mehta R H, O’Gara P T, Bossone E. et al . Acute type A aortic dissection in the elderly: clinical characteristics, management, and outcomes in the current era.  J Am Coll Cardiol. 2002;  40 685-692
• 10 Mehta R H, Bossone E, Evangelista A. et al . Acute type B aortic dissection in elderly patients: clinical features, outcomes, and simple risk stratification rule.  Ann Thorac Surg. 2004;  77 1622-1628; discussion 1629
• 11 Januzzi J L, Marayati F, Mehta R H. et al . Comparison of aortic dissection in patients with and without Marfan’s syndrome (results from the International Registry of Aortic Dissection).  Am J Cardiol. 2004;  94 400-402
• 12 Mehta R H, Manfredini R, Hassan F. et al . Chronobiological patterns of acute aortic dissection.  Circulation. 2002;  106 1110-1115