Characterization and trends in acute aortic syndromes: a single centre 10 year-analysis

Acute aortic syndrome (AAS) is a rare, but life-threatening condition. Despite recent advances, there is lack of contemporary data describing this population.

We performed a retrospective analysis of patients admitted with AAS in our centre in the last 10 years to characterize incidence, clinical course, risk factors and outcomes of this population.

There were 75 patients admitted with AAS, 90.7% aortic dissections (72.8% Stanford type A), 6.7% intramural hematomas and 2.7% penetrating ulcers. Patients were predominantly male (61.3%), with a mean age of 67±14 years.

Concerning risk factors, hypertension was the most common (66.2%), followed by dyslipidemia (33.8%), smoking (27%), diabetes (17.6%), family history of AAS (2.7%) and connective tissue disease (2.7%). Most patients had a symptom onset <24h (71.6%) and chest pain was the most frequent complaint (52.7%), followed by abdominal pain (18.9%) and syncope (18.9%). At admission, 28.8% of patients presented in shock, 26.3% had ischemic ECG changes, 8.2% had peripheral ischemia and 6.8% had acute cerebrovascular event.

Type A aortic dissection patients (n=49) had a median aortic diameter of 51.0mm (IQR 47-58) and 32.6% had a diameter <55mm. Among these patients, 70.8% underwent surgery, 4 patients died before surgery and 8 were not eligible due to comorbidities. Median length of hospital stay was 9 days (IQR 2-19), 5 patients were reintervened due to acute complications and the in-hospital mortality rate was 39.6%. During a median follow-up time of 11 months (IQR 0-71), 4 patients (11.7%) were submitted to another aortic procedure and 4 patients (14.8%) developed a MACCE event, with an overall mortality of 24.1% (7 patients).

Patients with type B aortic dissection (n=19) were older than type A (71±15 vs 64±13 years) but had a similar clinical presentation. They were predominantly treated conservatively (70.8%). In-hospital mortality was 15.8%. During follow-up time, there were 7.1% of MACCE events and overall mortality was 31.3%.

In our study, arterial hypertension remained the most prevalent risk factor in AAS patients. Clinical presentation was variable and almost one-third presented in shock. Acute aortic dissection, especially type A, was associated with a high rate of in-hospital and medium-term morbidity and mortality. A significant number of patients had an aortic diameter <55mm, highlighting the importance of controlling hypertension and other cardiovascular risk factors, to early recognise patients at risk.