BACKGROUND: Population-based epidemiologic studies of aortic dissections (ADs) are needed. This study aimed to report clinical characteristics, incidences, and mortality rates for adult patients admitted to Danish hospitals with type A AD (TAAD) or type B AD (TBAD) from 1996 through 2016. METHODS: We conducted a nationwide, population-based register study. All cases of AD registered with International Classification of Diseases, Tenth Revision codes in the Danish National Patient Registry at time of admission to a hospital with available medical records underwent validation. Data were merged between nationwide health registries including the cause of death registry. Patients with validated AD were matched 1:10 on sex and age with patients with hypertension from the general Danish population. RESULTS: Of 5018 registered cases of AD, 4183 cases underwent review and 3023 (60.2%) were confirmed as AD. After exclusions, the distribution of validated TAAD and TBAD was 1620 (60.5%) and 1059 (39.5%; P <0.001), 67.5% and 67.0% of patients were men, and mean ages at dissection were 63.5±12.9 and 67.5±12.2 years ( P <0.001), respectively. The most prevalent comorbidities for TAAD were hypertension (55.2%), thoracic aortic aneurysms (14.6%), and chronic obstructive pulmonary disease (13.1%); for TBAD, the most prevalent comorbidities were hypertension (64.1%), aortic aneurysms at any location (7.5% to 12.0%), and chronic obstructive pulmonary disease (15.7%). The overall mean annual incidence rate was 4.2/100 000 patient-years. Incidence was significantly higher for TAAD (2.2/100 000) compared with TBAD (1.5/100 000; P <0.001). The 30-day mortality rates for validated TAAD and TBAD were 22.0% and 13.9% ( P <0.001), respectively, with no significant changes over time or between sexes. Adjusted 5-year overall mortality rates for TAAD and TBAD were hazard ratio 3.2 (2.9 to 3.5; P <0.001; aortic-related cause of death, 57.0%) and hazard ratio 2.1 (1.9 to 2.4; P <0.001; aortic-related cause of death, 42.8%), respectively, compared with the general hypertensive population. Among patients who survived 30 days from dissection, the adjusted 5-year overall mortality rates were hazard ratio 1.1 (1.0 to 1.3; P =0.12; aortic-related cause of death, 23.2%) and hazard ratio 1.4 (1.2 to 1.6; P <0.001; aortic-related cause of death, 25.6%) for TAAD and TBAD, respectively. CONCLUSIONS: Hypertension, aortic aneurysms, and chronic obstructive pulmonary disease were the most prevalent comorbidities. The 30-day mortality frequencies were consistent over time with no significant differences between sexes. The 5-year mortality rate was higher for TAAD than TBAD. If the patient survived 30 days from dissection, the mortality rate for patients with TAAD was comparable with that of the general hypertensive population, but the mortality rate was significantly higher in patients with TBAD.
Purpose This study evaluated the validity of the ICD-10 diagnostic codes for aortic dissections (ADs) in the Danish National Patient Registry (DNPR) based upon positive predictive values (PPV). Patients and methods Cases registered in the DNPR with the unspecific AD diagnostic code DI710 (unspecified AD) from 1996 to 2016, and the specific AD diagnostic codes DI710A (AD Type A) and DI710B (AD Type B) from 2006 to 2016, were included. Available medical records from all registered cases underwent review. Confirmed cases of AD served as “gold standard” when reporting PPV. PPV estimates were stratified by regional differences, date, age at time of diagnosis, and sex. Results A total of 5018 cases were identified in the DNPR. After merging of data and retrieval of medical records, 3767 cases were eligible for validation. Of these, 2677 cases were verified as AD type A (59.7%), AD type B (38.8%), and unspecified type of AD (1.5%). The average age at diagnosis was 65.1 ±13.0 years (67.3% males). The overall PPV for having an AD when one of the three diagnostic codes were registered from 1996 to 2016 was 71.1% (95% confidence interval (CI): 69.6–72.5) and increased significantly over time. From 2006 to 2016, the PPV for the specific AD diagnostic codes was 89.5% (95% CI: 87.4–91.3), whilst the PPV for the unspecific diagnostic code was 63.5% (95% CI: 61.1–65.9). Conclusion We found the overall PPV for the pooled AD diagnostic codes in the DNPR acceptable. However, the two specific AD diagnostic codes presented remarkably higher PPV compared to the unspecific diagnostic code.
Oral communication abstractsby Doppler are associated to impaired trophoblast invasion but not to increased risk of aneuploidies. The aim of this study is to demonstrate that high resistence indices in UtA may play a role in explaining low PAPP-A levels not related with aneuploidies. Methods: Prospective study of 112 singleton pregnancies at highrisk for preeclampsia (at least having 1 major risk factor: prior history of preeclampsia, pregestational diabetes mellitus, chronic hypertension, chronic kidney disease, BMI > 30, autoimmune disorders or thrombophilia), booked for routine assessment of risk for aneuploidies by means of first trimester combined screening (NT + PAPP-A + β-hCG). Fetuses with abnormal karyotype were excluded. Measurement of NT and mean UtA pulsatility index (UtA-PI) were carried out at 11-14 weeks' scan. All values, including mean UtA-PI, were calculated in MoM, adjusted to gestational age. Results: Not significant correlations were found between mean UtA-PI and NT or between mean UtA-PI and β-hCG. Nevertheless, significant correlation was found between mean UtA-PI and PAPP-A (r value = −0.291; P = 0.02). When comparing the group of patients at increased risk (> 1/270) for trisomy 21 as assessed by combined screening (n = 8) with the low risk (< 1/270) group (n = 104), the greatest differences were found in PAPP-A values (0.37 vs. 0.97, P = 0.001), followed by β-hCG (1.89 vs. 1.22, P = 0.01) and NT (1.08 vs. 0.88, P = 0.02). Differences in mean UtA-PI were almost significant (1.16 vs. 1.00, P = 0.07). Conclusion: Mean UtA-PI at 11-14 weeks' scan may be an effectmodifier variable for PAPP-A that should be taken into account in the first-trimester combined screening for aneuploidies, at least in high-risk pregnancies for preeclampsia. OC007First trimester screening markers are altered in pregnancies conceived after IVF/ICSI
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