Population-Based Study of Incidence and Outcome of Acute Aortic Dissection and Premorbid Risk Factor Control: 10-Year Results From the Oxford Vascular Study

• Published in: Circulation (New York, N.Y.) N.Y.), 2013-05, Vol.127 (20), p.2031-2037
• Main Authors: Howard, Dominic P.J, Banerjee, Amitava, Fairhead, Jack F, Perkins, Jeremy, Silver, Louise E, Rothwell, Peter M
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aneurysm, Dissecting - epidemiology; Aneurysm, Dissecting - therapy; Aortic Aneurysm - epidemiology; Aortic Aneurysm - therapy; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Diseases of the aorta; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; England - epidemiology; Female; Follow-Up Studies; Humans; Incidence; Male; Medical sciences; Middle Aged; Population Surveillance - methods; Prospective Studies; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.112.000483

BACKGROUND—Acute aortic dissection is a preventable life-threatening condition. However, there have been no prospective population-based studies of incidence or outcome to inform an understanding of risk factors, strategies for prevention, or projections for future clinical service provision. METHODS AND RESULTS—We prospectively determined incidence and outcomes of all acute aortic dissections in a population of 92 728 in Oxfordshire, United Kingdom, from 2002 to 2012. Among 155 patients with 174 acute aortic events, 54 patients had 59 thoracoabdominal aortic dissections (52 incident events6/100 000, 95% confidence interval, 4–7; 37 Stanford type A, 15 Stanford type B; 31 men, mean age=72.0 years). Among patients with type A incident events, 18 (48.6%) died before hospital assessment (61.1% women). The 30-day fatality rate was 47.4% for patients with type A dissections who survived to hospital admission and 13.3% for patients with type B dissections, although subsequent 5-year survival rates were high (85.7% for type A; 83.3% for type B). Even though 67.3% of patients were on antihypertensive drugs, 46.0% of all patients had at least 1 systolic BP ≥180 mm Hg in their primary care records over the preceding 5 years, and the proportion of blood pressures in the hypertensive range (>140/90 mm Hg) averaged 56.0%. Premorbid blood pressure was higher in patients with type A dissections that were immediately fatal than in those who survived to admission (mean/standard deviation pre-event systolic blood pressure=151.2/19.3 versus 137.9/17.9; P