Acute Aortic Dissection: Perspectives from the International Registry of Acute Aortic Dissection (IRAD)

14-day mortality in 645 patients from IRAD stratified by medical and surgical treatment in both type A and B aortic dissection. Reproduced with permission from JAMA.⁷

Unadjusted Kaplan–Meier survival curve stratified by in-hospital management from date of hospital discharge in patients with Acute type A aortic dissection. Reproduced with permission from Circulation.¹⁸

Unadjusted Kaplan–Meier survival curve stratified by in-hospital management of patients with acute type B dissection who survive to hospital discharge. Reproduced with permission from Circulation.²³

In-hospital mortality for IMH according to site of origin. IMH was defined after first imaging test failed to demonstrate IMH or dissection but second test confirmed IMH or first study showed IMH but no evidence of dissection. Reproduced with permission from Circulation.³⁰

Kaplan–Meier survival curves from patients with and without pulse deficits; log-rank for curves of patients with 1, 2, or 3 or more pulse deficits differ from patients with no pulse deficits (P_0.03 and 0.004). Reproduced with permission from Am J Cardiol.³⁵

Overall number and percentage of study patients according to imaging study and the number and percentage according to imaging study of first choice. TTE=transthoracic echocardiography. Reproduced with permission from Am J Cardiol.³⁸

Model 1: observed versus model probabilities of death by score. Example: 77-year-old woman with migrating chest pain, pre-operative cardiac tamponade, a pulse deficit, and ST elevation. Her model score is 0.7 (age>70)+0.9 (migrating chest pain)+1.0 (pre-operative cardiac tamponade)+0.6 (pulse deficit)+0.6 (ST elevation). Total score=3.8. Drawing a line straight up from her risk score, the estimate of her surgical mortality risk is 61%. Reproduced with permission from Ann Thorac Surg.⁴⁰

Bar graph showing the incidence of mortality in type B AAD patients with different indications for surgical treatment. Reproduced with permission from Circulation.⁴⁴

Kaplan–Meier mortality cure stratified according to the status of the false lumen. P values were calculated by the log-rank test. Overall denotes comparison of all three curves. Reproduced with permission from N Engl J Med.⁵⁵

Conceptual model of risk according to the status of the false lumen: The figure shows a proposed model of the physiological consequences of false-lumen patency or thrombosis, based on hemodynamic studies in ex vivo models and in patients with aortic dissection. Panel A shows type B aortic dissection with patent proximal and patent distal reentry tears in the absence of thrombus. The blood-pressure tracing shows systolic, diastolic, and mean arterial pressures in the false lumen similar to the pressures in the true lumen. Panel B shows type B aortic dissection with a patent entry tear and partial thrombosis that occupies the inner circumference of the false lumen and obstructs the reentry tears, forming a blind sac. The blood-pressure tracing shows diastolic and mean arterial pressures in the false lumen that exceed the pressures seen in Panel A, with identical pressures in the true lumen. Panel C shows type B aortic dissection with a false lumen filled with thrombus and no longer communicating with the true lumen. The pressure within the false lumen is likely to be low and nonpulsatile. BP denotes blood pressure, and MAP mean arterial pressure. Reproduced with permission from N Engl J Med.⁵⁵