Current status of the management and outcomes of acute aortic dissection in Japan: Analyses of nationwide Japanese Registry of All Cardiac and Vascular Diseases-Diagnostic Procedure Combination data

Abstract

Background: Despite recent advances in the diagnosis and management, the mortality of acute aortic dissection remains high. This study aims to clarify the current status of the management and outcome of acute aortic dissection in Japan. Methods: A total of 18,348 patients with acute aortic dissection (type A: 10,131, type B: 8217) in the Japanese Registry of All Cardiac and Vascular Diseases database between April 2012–March 2015 were studied. Characteristics, clinical presentation, management, and in-hospital outcomes were analyzed. Results: Seasonal onset variation (autumn- and winter-dominant) was found in both types. More than 90% of patients underwent computed tomography for primary diagnosis. The overall in-hospital mortality of types A and B was 24.3% and 4.5%, respectively. The mortality in type A patients managed surgically was significantly lower than in those not receiving surgery (11.8% (799/6788) vs 49.7% (1663/3343); p<0.001). The number of cases managed endovascularly in type B increased 2.2-fold during the period, and although not statistically significant, the mortality gradually decreased (5.2% to 4.1%, p=0.49). Type A showed significantly longer length of hospitalization (median 28 days) and more than five times higher medical costs (6.26 million Japanese yen) than those in type B. The mean Barthel index at discharge was favorable in both type A (89.0±22.6) and type B (92.6±19.0). More than two-thirds of type A patients and nearly 90% of type B patients were directly discharged home. Conclusions: This nationwide study elucidated the clinical features and outcomes in contemporary patients with acute aortic dissections in real-world clinical practice in Japan.

Incidence and Mortality Rates of Thoracic Aortic Dissection in Korea – Inferred from the Nationwide Health Insurance Claims

“…In a recent study based on the nationwide Japanese Registry of All Cardiac and Vascular Disease database, Yamaguchi and colleagues demonstrated that the median hospital stay among patients who survived was 28 days in type A AD and 22 days in type B AD due to rehabilitation and nursing care during the same hospitalization period. 23 24 …”

Frozen elephant trunk usage in acute aortic dissection

“…On the other hand, the Japanese Registry of All Cardiac and Vascular Diseases database has the data of patients who had medical or surgical treatment for acute type A aortic dissection. 10 Patients who had non-surgical treatment comprised 33% of 10,131 patients from April 2012 to March 2015. The early mortality of patients with medical treatment was reported to be much higher (49.7%) compared to surgical cases (11.8%).…”

New clues for optimal diagnosis and treatment of an old foe: the acute aortic syndrome

“…The epidemiology of acute aortic syndromes is further elucidated in a descriptive analysis of 18,348 patients with acute aortic syndrome captured in the Japanese Registry of All Cardiac and Vascular Diseases. 3 This large dataset provides novel insight into possible seasonal variations in the incidence of acute aortic syndromes (autumn–winter predominant), and important trends in approaches to management, with a more than two-fold increase in the use of endovascular management of type B dissection. Unfortunately, although outcomes are improving, mortality rates remain high, particularly for type A dissection (24.3%) and most notably for those not treated surgically (49.7%); again underscoring the need for better prevention and early diagnosis and treatment.…”