Published date: Nov 21 2024

Journal Title: Dubai Medical Journal

Issue title: Dubai Medical Journal (DMJ): Volume 7 Issue 2

Pages: 94–104

DOI: 10.18502/dmj.v7i2.17674

Ivyan Kambalevian.kambal@hotmail.comEmergency Medicine Department, Rashid Hospital Trauma Center, Dubai Health, Dubai

Esra AlHamadaniEmergency Medicine Department, Rashid Hospital Trauma Center, Dubai Health, Dubai

Sania ZiaEmergency Medicine Department, Rashid Hospital Trauma Center, Dubai Health, Dubai

Rand AboelkherEmergency Medicine Department, Rashid Hospital Trauma Center, Dubai Health, Dubai

Firas AlNajjarEmergency Medicine Department, Rashid Hospital Trauma Center, Dubai Health, Dubai

Objectives: Aortic dissection is a life-threatening condition, with a high mortality rate. It can be classified into Stanford type A or type B. This study reports the clinical presentation, risk factors, systolic blood pressure, and the mortality rate of patients with confirmed aortic dissection on computed tomography (CT) imaging. Mortality rate on weekends, weekdays, daytime, and night-time were also reported.

Methods: A retrospective review of electronic health records of all patients requiring CT aortogram in the emergency department (ED) between 2013 and 2022 were examined. Patients with confirmed acute aortic dissection on CT were included. Presenting symptoms, demographics, and mortality rate were described and reported for type A and type B aortic dissection.

Results: Of 315 patients, 65 had confirmed acute aortic dissection on CT imaging. The mean age at presentation was 50.6 years and the majority of the cohort were male (83%). Chest pain was the most common symptom (43%). A history of hypertension was present in 65% of the subjects. D-dimer was elevated in 95% of the patients. The overall in-hospital mortality was 18.5%, with a mortality rate of 40% in type A aortic dissection.

Conclusion: Aortic dissection can occur with various symptoms, and therefore, requires a high index of suspicion. Chest X-ray has a low sensitivity in detecting aortic dissection and should not be used to rule out aortic dissection. D-dimer can be used as a diagnostic assay in ruling out aortic dissection. Type A aortic dissection has the highest mortality rate and hence necessitates prompt intervention.

Keywords: mortality rate, aortic dissection, demographics, risk factors, UAE

[1] Gawinecka J, Schönrath F, von Eckardstein A. Acute aortic dissection: Pathogenesis, risk factors and diagnosis. Swiss Med Wkly. 2017;147:w14489. Published 2017 Aug 25. doi:10.4414/smw.2017.14489.

[2] Su IM, Huang HK, Liu PP, Hsu JY, Lin SM, Loh CH. Mortality risk from acute aortic dissection among hospital admissions during weekends and holiday season. PLoS One. 2021;16(9):e0255942. Published 2021 Sep 1. doi:10.1371/journal.pone.0255942.

[3] Landenhed M, Engström G, Gottsäter A, Caulfield MP, Hedblad B, Newton-Cheh C, et al. Risk profiles for aortic dissection and ruptured or surgically treated aneurysms: A prospective cohort study. J Am Heart Assoc. 2015;4(1):e001513. Published 2015 Jan 21. doi:10.1161/JAHA.114.001513.

[4] Levy D, Goyal A, Grigorova Y, Farci F, Le JK. Aortic dissection. StatPearls. Treasure Island (FL): StatPearls Publishing; April 23, 2023.

[5] Obel LM, Lindholt JS, Lasota AN, Jensen HK, Benhassen LL, Mørkved AL, et al. Clinical characteristics, incidences, and mortality rates for Type A and B aortic dissections: A nationwide Danish population-based cohort study from 1996 to 2016. Circulation. 2022;146(25):1903-1917. doi:10.1161/CIRCULATIONAHA.122.061065.

[6] Maitusong B, Sun HP, Xielifu D, Mahemuti M, Ma X, Liu F, et al. Sex-related differences between patients with symptomatic acute aortic dissection. Medicine (Baltimore). 2016;95(11):e3100. doi:10.1097/MD.0000000000003100.

[7] Zhou Z, Cecchi AC, Prakash SK, Milewicz DM. Risk factors for thoracic aortic dissection. Genes (Basel). 2022;13(10):1814. Published 2022 Oct 7. doi:10.3390/genes13101814.

[8] Grubb KJ, Kron IL. Sex and gender in thoracic aortic aneurysms and dissection. Semin Thorac Cardiovasc Surg. 2011;23(2):124-125. doi:10.1053/j.semtcvs.2011.08.009.

[9] Friedrich C, Salem MA, Puehler T, Hoffmann G, Lutter G, Cremer J, et al. Sex-specific risk factors for early mortality and survival after surgery of acute aortic dissection type a: A retrospective observational study. J Cardiothorac Surg. 2020;15(1):145. Published 2020 Jun 18. doi:10.1186/s13019-020-01189-w.

[10] Gasser S, Stastny L, Kofler M, Krapf C, Bonaros N, Grimm M, et al. Type A aortic dissection is more aggressive in women. Eur J Cardiothorac Surg. 2022;62(2):ezac040. doi:10.1093/ejcts/ezac040.

[11] Wu S, Cao C, Lun Y, Jiang H, Wang S, He Y, et al. Age-related differences in acute aortic dissection. J Vasc Surg. 2022;75(2):473-483.e4. doi:10.1016/j.jvs.2021.08.086

[12] Sayed A, Munir M, Bahbah EI. Aortic Dissection: A Review of the Pathophysiology, Management and Prospective Advances. Curr Cardiol Rev. 2021;17(4):e230421186875. doi.org/10.2174/1573403X16666201014142930.

[13] Howard DP, Sideso E, Handa A, Rothwell PM. Incidence, risk factors, outcome and projected future burden of acute aortic dissection. Ann Cardiothorac Surg. 2014;3(3):278-284. doi:10.3978/j.issn.2225- 319X.2014.05.14.

[14] Evangelista A, Isselbacher EM, Bossone E, Gleason TG, Eusanio MD, Sechtem U, et al. Insights from the International Registry of Acute Aortic Dissection: A 20-year experience of collaborative clinical research. Circulation. 2018;137(17):1846-1860. doi:10.1161/CIRCULATIONAHA.117.031264.

[15] Hibino M, Otaki Y, Kobeissi E, Pan H, Hibino H, Taddese H, et al. Blood pressure, hypertension, and the risk of aortic dissection incidence and mortality: Results from the J-SCH study, the UK Biobank study, and a meta-analysis of cohort studies. Circulation. 2022;145(9):633-644. doi:10.1161/CIRCULATIONAHA.121.056546.

[16] Bossone E, Gorla R, LaBounty TM, Suzuki T, Gilon D, Strauss C, et al. Presenting systolic blood pressure and outcomes in patients with acute aortic dissection. J Am Coll Cardiol. 2018;71(13):1432- 1440. doi:10.1016/j.jacc.2018.01.064.

[17] Zhou Y, Luo Q, Guo X, Wang H, Jia Y, Cao L, et al. Predictive value of heart rate in patients with acute type A aortic dissection: A retrospective cohort study. BMJ Open. 2021;11(11):e047221. Published 2021 Nov 11. doi:10.1136/bmjopen-2020-047221.

[18] Alsous F, Islam A, Ezeldin A, Zarich S. Potential pitfalls in the diagnosis of aortic dissection. Conn Med. 2003;67(3):131-134.

[19] von Kodolitsch Y, Nienaber CA, Dieckmann C, Schwartz AG, Hofmann T, Brekenfeld H, et al. Chest radiography for the diagnosis of acute aortic syndrome. Am J Med. 2004;116(2):73-77. doi:10.1016/j.amjmed.2003.08.030.

[20] Freemantle N, Ray D, McNulty D, Rosse D, Bennett S, Keogh BE, et al. Increased mortality associated with weekend hospital admission: A case for expanded seven day services? [published correction appears in BMJ. 2016;352:i1762]. BMJ. 2015;351:h4596. Published 2015 Sep 5. doi:10.1136/bmj.h4596.

[21] Glance LG, Osler T, Li Y, Lustik SJ, Eaton MP, Dutton RP, et al. Outcomes are worse in US patients undergoing surgery on weekends compared with weekdays. Med Care. 2016;54(6):608-615. doi:10.1097/MLR.0000000000000532.

[22] Ahlsson A, Wickbom A, Geirsson A, Franco-Cereceda A, Ahmad K, Gunn J, et al. Is there a weekend effect in surgery for type A dissection? Results from the Nordic Consortium for acute Type A aortic dissection database. Ann Thorac Surg. 2019;108(3):770-776. doi:10.1016/j.athoracsur.2019.03.005.

[23] Pape LA, Awais M, Woznicki EM, Suzuki T, Trimarchi S, Evangelista A, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the International Registry of Acute Aortic Dissection. J Am Coll Cardiol. 2015;66(4):350-358. doi:10.1016/j.jacc.2015.05.029.

[24] Suzuki T, Distante A, Zizza A, Santi Trimarchi, Massimo Villani, et al. Diagnosis of acute aortic dissection by D-dimer: The International Registry of Acute Aortic Dissection substudy on biomarkers (IRAD-Bio) experience. Circulation. 2009;119(20):2702-2707. doi:10.1161/CIRCULATIONAHA.108.833004.

[25] Yao J, Bai T, Yang B, Sun L. The diagnostic value of D-dimer in acute aortic dissection: A meta-analysis. J Cardiothorac Surg. 2021;16(1):343. Published 2021 Nov 27. doi:10.1186/s13019-021-01726-1.

[26] Wang D, Chen J, Sun J, Chen H, Li F, Wang J. The diagnostic and prognostic value of D-dimer in different types of aortic dissection. J Cardiothorac Surg. 2022;17(1):194. Published 2022 Aug 20. doi:10.1186/s13019-022-01940-5.