Epidemiology of thoracic aortic dissection

Abstract

Thoracic aortic dissection (TAD) is estimated to occur at a rate of 3-4 cases per 100,000 persons per year and is associated with a high mortality. Reported rates are probably underestimates of the true incidence of TAD because of difficulties in diagnosis. The incidence of TAD appears to have been increasing over time. TAD is most common in men and older individuals. Aortic dilatation is a well-established risk factor for TAD but is not a prerequisite; most ascending aortic dissections occur when aortic diameter is <5.5 cm. Although atherosclerosis and typical cardiovascular risk factors, such as hypertension and smoking, are associated with TAD, evidence supporting their direct causal role is lacking. Notably, diabetes mellitus is remarkably uncommon in patients with TAD. Other risk factors for TAD include inflammatory diseases, iatrogenic aortic injury, and drug use. Congenital cardiovascular defects, such as bicuspid aortic valve, and certain genetic syndromes, such as Marfan syndrome, are the genetic factors most commonly associated with TAD. Specific nonsyndromic genetic mutations in families and single nucleotide polymorphisms have also been identified as possible risk factors for TAD.

False Lumen Status in Patients With Acute Aortic Dissection: A Systematic Review and Meta‐Analysis

“…However, long‐term outcomes for AAD patients with type B dissection are not necessarily better than those having type A. Long‐term survival of surgically treated patients with type B AAD after discharge ranges from 56% to 96% at 1 year and from 48% to 83% at 5 years 4, 5, 6, 7, 8. In contrast, for surgically treated type A patients who survive until hospital discharge, survival rates range from 52% to 96% at 1 year and from 37% to 91% at 5 years 8, 9, 10, 11, 12. Therefore, given the variable prognosis of AAD with current management strategies, it is necessary to establish predictors of poor outcomes for targeted therapy.…”

Association of the polymorphisms of MMP-9 and TIMP-3 genes with thoracic aortic dissection in Chinese Han population

“…Studies on the pathogenesis of this disease may shed light on the prevention and treatment of dissection. It is believed that hypertension is the main etiological risk factor in aortic dissection development [3] . Meanwhile, a number of genetic conditions are also associated with dissection, such as Marfan syndrome_ENREF_1 [4] and Loeys-Dietz syndrome [5] .…”

Type A Aortic Dissection After Nonaortic Cardiac Surgery

“…Population-based studies suggest an incidence of ≈20 to 30 cases per million people per year which roughly translates to an estimated >6000 new AAD cases annually in the United States and >14 000 in Europe. [1][2][3][4][5] The clinical presentation, natural history, management, and outcome of spontaneous AADs are well described.2,5-7 Despite improvements in imaging, surgical techniques, and management, the overall in-hospital mortality of patients with spontaneous acute AAD remains high with a range of 15% to 32%, 7-10 with early death resulting mainly from rupture and tamponade. …”