- Email: [email protected]
DIAGNOSTIC DELAYS IN TYPE B AORTIC DISSECTIONS
2245 JACC April 5, 2016 Volume 67, Issue 13
Vascular Medicine DIAGNOSTIC DELAYS IN TYPE B AORTIC DISSECTIONS Moderated Poster Contributions Vascular Medicine Moderated Poster Theater, Poster Area, South Hall A1 Saturday, April 02, 2016, 4:00 p.m.-4:10 p.m. Session Title: Challenges in the Care of Patients With Peripheral Artery Disease: Right Patient, Right Care, Right Time Abstract Category: 44. Vascular Medicine: Non Coronary Arterial Disease Presentation Number: 1164M-03 Authors: Thomas Goslinga, James Froehlich, Arturo Evangelista, Kevin Harris, G. Chad Hughes, Firas F. Mussa, Stuart Hutchison, Linda Pape, Mark Peterson, Udo Sechtem, Truls Myrmel, Philippe Steg, Daniel Montgomery, Christoph A. Nienaber, Eric Isselbacher, Kim Eagle, Troy LaBounty, University of Michigan, Ann Arbor, MI, USA
Background: Acute aortic conditions, including aortic dissection and intramural hematoma, are very serious illnesses that require prompt and appropriate medical attention, with misdiagnosis being potentially fatal. It is well understood that fast diagnosis and treatment is crucial to obtain optimal outcomes for patients with Type A aortic dissection, but the same cannot currently be supported by evidence for Type B acute aortic dissection (TBAAD). We were interested in determining what variables might alter time to diagnosis for patients with TBAAD, as well as whether or not a faster time to diagnosis resulted in better outcomes. Methods: Utilizing data from the International Registry of Acute Aortic Dissection (IRAD), we examined TBAAD patients with available data (N=887), and divided them into two groups: above and below the median delay from initial hospitalization to confirmed diagnosis (3.0 hours).
Results: Patients with shorter versus longer time to diagnosis had differences in the prevalence of back pain (75.8% vs 69.8%, p=0.047), systolic blood pressure (168.5 ± 42.5 vs 162.1 ± 37.4 mmHg, p=0.018), familial history of aortic disease (16.4% vs 9.9%, p=0.049), history of aortic dissection (8.6% vs 4.8%, p=0.025), and painless presentation (0.7% vs 2.3%, p=0.049). No significant differences in in-hospital and follow-up outcome measures were found between groups. Conclusions: Presenting above or below the median time to diagnosis does not seem to impact outcomes in TBAAD. This may be due in part to early initiation of antihypertensive drugs, a treatment that is often started empirically before the definitive diagnosis even occurs. IRAD currently does not capture the timing of initial medication administration, but such data might show that time to treatment is what really has an effect on outcomes. This data supports previous publications demonstrating a less rapid decline in survival during the hyperacute period for TBAAD patients compared to their Type A counterparts. While identification of dissection is critical to employing appropriate treatment, it appears that immediate attention to hypertensive crises and signs of shock or malperfusion may be more emergent concerns.
Vascular Medicine DIAGNOSTIC DELAYS IN TYPE B AORTIC DISSECTIONS Moderated Poster Contributions Vascular Medicine Moderated Poster Theater, Poster Area, South Hall A1 Saturday, April 02, 2016, 4:00 p.m.-4:10 p.m. Session Title: Challenges in the Care of Patients With Peripheral Artery Disease: Right Patient, Right Care, Right Time Abstract Category: 44. Vascular Medicine: Non Coronary Arterial Disease Presentation Number: 1164M-03 Authors: Thomas Goslinga, James Froehlich, Arturo Evangelista, Kevin Harris, G. Chad Hughes, Firas F. Mussa, Stuart Hutchison, Linda Pape, Mark Peterson, Udo Sechtem, Truls Myrmel, Philippe Steg, Daniel Montgomery, Christoph A. Nienaber, Eric Isselbacher, Kim Eagle, Troy LaBounty, University of Michigan, Ann Arbor, MI, USA
Background: Acute aortic conditions, including aortic dissection and intramural hematoma, are very serious illnesses that require prompt and appropriate medical attention, with misdiagnosis being potentially fatal. It is well understood that fast diagnosis and treatment is crucial to obtain optimal outcomes for patients with Type A aortic dissection, but the same cannot currently be supported by evidence for Type B acute aortic dissection (TBAAD). We were interested in determining what variables might alter time to diagnosis for patients with TBAAD, as well as whether or not a faster time to diagnosis resulted in better outcomes. Methods: Utilizing data from the International Registry of Acute Aortic Dissection (IRAD), we examined TBAAD patients with available data (N=887), and divided them into two groups: above and below the median delay from initial hospitalization to confirmed diagnosis (3.0 hours).
Results: Patients with shorter versus longer time to diagnosis had differences in the prevalence of back pain (75.8% vs 69.8%, p=0.047), systolic blood pressure (168.5 ± 42.5 vs 162.1 ± 37.4 mmHg, p=0.018), familial history of aortic disease (16.4% vs 9.9%, p=0.049), history of aortic dissection (8.6% vs 4.8%, p=0.025), and painless presentation (0.7% vs 2.3%, p=0.049). No significant differences in in-hospital and follow-up outcome measures were found between groups. Conclusions: Presenting above or below the median time to diagnosis does not seem to impact outcomes in TBAAD. This may be due in part to early initiation of antihypertensive drugs, a treatment that is often started empirically before the definitive diagnosis even occurs. IRAD currently does not capture the timing of initial medication administration, but such data might show that time to treatment is what really has an effect on outcomes. This data supports previous publications demonstrating a less rapid decline in survival during the hyperacute period for TBAAD patients compared to their Type A counterparts. While identification of dissection is critical to employing appropriate treatment, it appears that immediate attention to hypertensive crises and signs of shock or malperfusion may be more emergent concerns.