PDF(Pubmed)
Abstract：
OBJECTIVE: To describe the incidence of acute aortic dissection in a clearly defined population, to assess onset symptoms and admission biochemical marker levels and to analyse variables potentially associated to mortality.
METHODS: Medical records and CT angiograms of all patients hospitalised for acute aortic dissection in the Stockholm County during the 5-year period 2012-2016 were reviewed. The patients were followed until date of death or until 31 December 2020. The annual incidence was determined. Associations between clinical and biochemical variables and 30-day mortality, respectively, were analysed using multivariable logistic regression models.
RESULTS: A total of 344 patients were included. The mean annual incidence of acute aortic dissection was 4.1 per 100 000. Median age was 67 years (range 24-91) and 34% (n=118) were women. Type A dissection was predominant; 220 patients (64%) had type A and 124 (36%) had type B. Painless dissection was more common in type A than in type B (18% vs 15%, p=0.003). Type A dissection patients also more commonly had elevated plasma troponin T (44% vs 21%, p<0.001) and thrombocytopenia (26% vs 15%, p=0.010) than type B dissection patients on admission. Overall, 30-day mortality was 28% in type A and 11% in type B (p<0.001). Both painless dissection (OR 4.30, 95% CI 1.80 to 10.28, p=0.001) and elevated troponin T (OR 3.78, 95% CI 2.01 to 7.12, p<0.001), respectively, were associated with increased 30-day mortality in all acute aortic dissection patients. Thrombocytopenia was associated with elevated 30-day mortality only in patients with type A (OR 3.09, 95% CI 1.53 to 6.21, p=0.002).
CONCLUSIONS: Nearly two-thirds of acute aortic dissection patients had type A. Levels of troponin T and platelets, respectively, paired with presence or absence of typical symptoms may become useful adjuncts in risk stratification of patients with acute aortic dissection.
METHODS: Medical records and CT angiograms of all patients hospitalised for acute aortic dissection in the Stockholm County during the 5-year period 2012-2016 were reviewed. The patients were followed until date of death or until 31 December 2020. The annual incidence was determined. Associations between clinical and biochemical variables and 30-day mortality, respectively, were analysed using multivariable logistic regression models.
RESULTS: A total of 344 patients were included. The mean annual incidence of acute aortic dissection was 4.1 per 100 000. Median age was 67 years (range 24-91) and 34% (n=118) were women. Type A dissection was predominant; 220 patients (64%) had type A and 124 (36%) had type B. Painless dissection was more common in type A than in type B (18% vs 15%, p=0.003). Type A dissection patients also more commonly had elevated plasma troponin T (44% vs 21%, p<0.001) and thrombocytopenia (26% vs 15%, p=0.010) than type B dissection patients on admission. Overall, 30-day mortality was 28% in type A and 11% in type B (p<0.001). Both painless dissection (OR 4.30, 95% CI 1.80 to 10.28, p=0.001) and elevated troponin T (OR 3.78, 95% CI 2.01 to 7.12, p<0.001), respectively, were associated with increased 30-day mortality in all acute aortic dissection patients. Thrombocytopenia was associated with elevated 30-day mortality only in patients with type A (OR 3.09, 95% CI 1.53 to 6.21, p=0.002).
CONCLUSIONS: Nearly two-thirds of acute aortic dissection patients had type A. Levels of troponin T and platelets, respectively, paired with presence or absence of typical symptoms may become useful adjuncts in risk stratification of patients with acute aortic dissection.
摘要：
目的：描述明确定义人群中急性主动脉夹层的发生率，评估发病症状和入院生化标志物水平,并分析可能与死亡率相关的变量.
方法：回顾2012-2016年斯德哥尔摩县所有因急性主动脉夹层住院患者的病历和CT血管造影。对患者进行随访，直至死亡日期或2020年12月31日。确定了年发病率。临床和生化变量与30天死亡率之间的关联，分别,采用多变量Logistic回归模型进行分析。
结果：共纳入344例患者。急性主动脉夹层的年平均发病率为4.1/100000。中位年龄为67岁（范围24-91），女性占34％（n=118）。A型夹层占优势；A型220例（64％），B型124例（36％）。A型无痛夹层比B型更常见（18％vs15％，p=0.003)。A型夹层患者的血浆肌钙蛋白T也更常见（44％vs21％，p<0.001）和血小板减少症（26%vs15%，p=0.010）比入院时B型夹层患者高。总的来说,A型30天死亡率为28%，B型为11%(p<0.001)。无痛剥离术（OR4.30，95％CI1.80至10.28，p=0.001）和肌钙蛋白T升高（OR3.78，95％CI2.01至7.12，p<0.001），分别,与所有急性主动脉夹层患者30日死亡率增加相关.仅在A型患者中，血小板减少与30天死亡率升高相关（OR3.09，95％CI1.53至6.21，p=0.002）。
结论：近三分之二的急性主动脉夹层患者存在A型肌钙蛋白T和血小板水平，分别,在急性主动脉夹层患者的危险分层中,存在或不存在典型症状可能成为有用的辅助手段.
方法：回顾2012-2016年斯德哥尔摩县所有因急性主动脉夹层住院患者的病历和CT血管造影。对患者进行随访，直至死亡日期或2020年12月31日。确定了年发病率。临床和生化变量与30天死亡率之间的关联，分别,采用多变量Logistic回归模型进行分析。
结果：共纳入344例患者。急性主动脉夹层的年平均发病率为4.1/100000。中位年龄为67岁（范围24-91），女性占34％（n=118）。A型夹层占优势；A型220例（64％），B型124例（36％）。A型无痛夹层比B型更常见（18％vs15％，p=0.003)。A型夹层患者的血浆肌钙蛋白T也更常见（44％vs21％，p<0.001）和血小板减少症（26%vs15%，p=0.010）比入院时B型夹层患者高。总的来说,A型30天死亡率为28%，B型为11%(p<0.001)。无痛剥离术（OR4.30，95％CI1.80至10.28，p=0.001）和肌钙蛋白T升高（OR3.78，95％CI2.01至7.12，p<0.001），分别,与所有急性主动脉夹层患者30日死亡率增加相关.仅在A型患者中，血小板减少与30天死亡率升高相关（OR3.09，95％CI1.53至6.21，p=0.002）。
结论：近三分之二的急性主动脉夹层患者存在A型肌钙蛋白T和血小板水平，分别,在急性主动脉夹层患者的危险分层中,存在或不存在典型症状可能成为有用的辅助手段.
