Clinical profiles and outcomes of acute type B aortic dissection in the current era: lessons from the International Registry of Aortic Dissection (IRAD)

Background - Clinical profiles and outcomes of patients with acute type B aortic dissection have not been evaluated in the current era. Methods and Results - Accordingly, we analyzed 384 patients ( 65 +/- 13 years, males 71%) with acute type B aortic dissection enrolled in the International Registry of Acute Aortic Dissection (IRAD). A majority of patients had hypertension and presented with acute chest/back pain. Only one-half showed abnormal findings on chest radiograph, and almost all patients had computerized tomography (CT), transesophageal echocardiography, magnetic resonance imaging (MRI), and/or aortogram to confirm the diagnosis. In-hospital mortality was 13% with most deaths occurring within the first week. Factors associated with increased in-hospital mortality on univariate analysis were hypotension/ shock, widened mediastinum, periaortic hematoma, excessively dilated aorta ( greater than or equal to 6 cm), in-hospital complications of coma/altered consciousness, mesenteric/limb ischemia, acute renal failure, and surgical management ( all P < 0.05). A risk prediction model with control for age and gender showed hypotension/ shock ( odds ratio [ OR] 23.8, P = 0.0001), absence of chest/back pain on presentation ( OR 3.5, P = 0.01), and branch vessel involvement ( OR 2.9, P = 0.02), collectively named `the deadly triad' to be independent predictors of in-hospital death. Conclusions - Our study provides insight into current-day profiles and outcomes of acute type B aortic dissection. Factors associated with increased in-hospital mortality ("the deadly triad") should be identified and taken into consideration for risk stratification and decision-making.