Wang et al
Acquired Cardiovascular Disease
Clinical features of acute aortic dissection from the Registry of Aortic Dissection in China Weiguang Wang, MD,a Weixun Duan, MD,a Yang Xue, MD,b Ling Wang, PhD,c Jincheng Liu, MD,a Shiqiang Yu, MD,a and Dinghua Yi, MD,a on behalf of the Registry of Aortic Dissection in China (Sino-RAD) Investigators Objective: To establish a systematic registry of aortic dissection in China, assess the clinical features of Chinese patients with acute aortic dissection (AAD), and compare our results with the data published by the International Registry of Acute Aortic Dissection (IRAD). Methods: We established the first Registry of Aortic Dissection in China (Sino-RAD) in 2011. Then we evaluated 1003 patients with AAD in Sino-RAD and compared our results with those reported by IRAD. Results: Compared with IRAD, the patients with AAD in Sino-RAD were significantly younger. Also, the ratio of male patients in Sino-RAD was significantly greater for the total cohort and the type A and B cohorts. The overall in-hospital mortality was 10.3% in Sino-RAD. For type A dissection, more patients in Sino-RAD received medical treatment and fewer received surgical treatment. The overall mortality, mortality of medical treatment, and mortality of surgical treatment was lower in Sino-RAD. In type B dissection, fewer patients in Sino-RAD received medical and surgical treatment and more received endovascular treatment.
See related commentary on pages 3001-2. Acute aortic dissection (AAD) is an age-dependent, lifethreatening cardiovascular disease associated with high mortality owing to potentially fatal complications.1-7 Because of the high mortality and relatively low incidence of AAD, it is necessary to collect data on a larger number of patients within a short period to effectively describe the clinical manifestations, diagnosis, management, and outcomes of this aggressive disease. The International Registry of Acute Aortic Dissection (IRAD), established in 1996, provides an opportunity to study large groups of patients with AAD. The data published by IRAD were helpful in improving the From the Department of Cardiovascular Surgery,a Xijing Hospital, State Key Laboratory of Military Stomatology, Department of Oral Biology,b School of Stomatology, and Department of Health Statistics,c Fourth Military Medical University, Xi’an, Shaanxi, People’s Republic of China. This work was supported by grant 2011BAI11B20 from the National Key Technology Research and Development Program for 12th Five-Year Plan (Beijing, China). Disclosures: Authors have nothing to disclose with regard to commercial support. W.W., W.D., and Y.X. contributed equally to the present study. Received for publication May 15, 2014; revisions received July 15, 2014; accepted for publication July 31, 2014. Address for reprints: Dinghua Yi, MD, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, 129 West Changle Rd, Xi’an, Shaanxi 710032, People’s Republic of China (E-mail: [email protected]). 0022-5223/$36.00 Copyright Ó 2014 Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery http://dx.doi.org/10.1016/j.jtcvs.2014.07.068
diagnosis and management of AAD.1,6,8-19 However, most patients included in the IRAD are from developed countries withadvanced medical care. Thus, the datafromthe IRAD will not reflect the current reality of patients with AAD in China. To better understand the clinical features of AAD in Chinese population,achievepossibleimprovementsinitsdiagnosisand treatment, and be able to systematically com-pare the current situation of AAD domestically and abroad, it was urgent to establisharegistryofaorticdissectioninChina. Therefore, we established the first Registry of Aortic Dissection in China (Sino-RAD). Then, the 1003 patients with AAD included in the Sino-RAD were evaluated and compared with the data reported by IRAD. A preliminary investigation of the differences between the patients included in Sino-RAD and those included in IRAD could provide potentially useful insights into further understanding of the disease for cardiovascular disease scientists. METHODS Establishment of the Sino-RAD In 2011, the establishment of the first Registry of Aortic Dissection in China (available at: www.Sino-RAD.com) was led by the Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University. Another 14 large cardiovascular centers in China are also participating in the registry. The centers cover most of the east and midland of China.
Patient Selection All patients with AAD were enrolled from January 1, 2012, to December 31, 2013. The diagnosis was determined from the history,
The Journal of Thoracic and Cardiovascular Surgery c Volume 148, Number 6
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ACD
Conclusions: The first Sino-RAD, including 15 large cardiovascular centers throughout China, was established. Our data were compared with those reported by IRAD. We found that, compared with Western populations, Chinese patients with AAD showed 6 differences, including earlier onset, more male patients, a low incidence of hypertension, a low incidence of chest pain, a high incidence of back pain, great differences in the choice of therapeutic strategies, and relatively low in-hospital mortality. (J Thorac Cardiovasc Surg 2014;148:2995-3000)
Acquired Cardiovascular Disease
Abbreviations and Acronyms AAD ¼ acute aortic dissection IRAD ¼ International Registry of Acute Aortic Dissection Sino-RAD ¼ Registry of Aortic Dissection in China physical examination findings, imaging study findings, visualization at surgery, and/or postmortem examination. Patients with aortic disruption secondary to trauma were excluded.
Data Collection A questionnaire, defined according to standard definitions, including demographic data, history, physical findings, management, imaging studies, and outcomes, was developed. The acute stage was confined to the initial 14 days after symptom onset. Data were collected at presentation or by physician review of the hospital records and were forwarded to the Sino-RAD Coordinating Center at the Fourth Military Medical University. The forms were reviewed for clinical face validity and analytical internal validity. The IRAD data were taken from reports published publicly in 2000,1 2004,20 and 2007.21
Statistical Analysis Categorical data are presented as frequencies and percentages and continuous data as the mean standard deviation. The continuous variables were compared using the Student t test for normal distributions and the Mann-Whitney U test for non-normal distributions. The categorical variables were compared using the chi-square test or Fisher’s exact test, as appropriate. Data analysis was performed using the Statistical Package for Social Sciences, version 18.0 (SPSS, Chicago, Ill).
ACD
RESULTS Demographic Data A total of 1003 patients with AAD were enrolled in SinoRAD (Table 1). Compared with IRAD, the patients with AAD in Sino-RAD were significantly younger (P
Acquired Cardiovascular Disease
Clinical features of acute aortic dissection from the Registry of Aortic Dissection in China Weiguang Wang, MD,a Weixun Duan, MD,a Yang Xue, MD,b Ling Wang, PhD,c Jincheng Liu, MD,a Shiqiang Yu, MD,a and Dinghua Yi, MD,a on behalf of the Registry of Aortic Dissection in China (Sino-RAD) Investigators Objective: To establish a systematic registry of aortic dissection in China, assess the clinical features of Chinese patients with acute aortic dissection (AAD), and compare our results with the data published by the International Registry of Acute Aortic Dissection (IRAD). Methods: We established the first Registry of Aortic Dissection in China (Sino-RAD) in 2011. Then we evaluated 1003 patients with AAD in Sino-RAD and compared our results with those reported by IRAD. Results: Compared with IRAD, the patients with AAD in Sino-RAD were significantly younger. Also, the ratio of male patients in Sino-RAD was significantly greater for the total cohort and the type A and B cohorts. The overall in-hospital mortality was 10.3% in Sino-RAD. For type A dissection, more patients in Sino-RAD received medical treatment and fewer received surgical treatment. The overall mortality, mortality of medical treatment, and mortality of surgical treatment was lower in Sino-RAD. In type B dissection, fewer patients in Sino-RAD received medical and surgical treatment and more received endovascular treatment.
See related commentary on pages 3001-2. Acute aortic dissection (AAD) is an age-dependent, lifethreatening cardiovascular disease associated with high mortality owing to potentially fatal complications.1-7 Because of the high mortality and relatively low incidence of AAD, it is necessary to collect data on a larger number of patients within a short period to effectively describe the clinical manifestations, diagnosis, management, and outcomes of this aggressive disease. The International Registry of Acute Aortic Dissection (IRAD), established in 1996, provides an opportunity to study large groups of patients with AAD. The data published by IRAD were helpful in improving the From the Department of Cardiovascular Surgery,a Xijing Hospital, State Key Laboratory of Military Stomatology, Department of Oral Biology,b School of Stomatology, and Department of Health Statistics,c Fourth Military Medical University, Xi’an, Shaanxi, People’s Republic of China. This work was supported by grant 2011BAI11B20 from the National Key Technology Research and Development Program for 12th Five-Year Plan (Beijing, China). Disclosures: Authors have nothing to disclose with regard to commercial support. W.W., W.D., and Y.X. contributed equally to the present study. Received for publication May 15, 2014; revisions received July 15, 2014; accepted for publication July 31, 2014. Address for reprints: Dinghua Yi, MD, Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, 129 West Changle Rd, Xi’an, Shaanxi 710032, People’s Republic of China (E-mail: [email protected]). 0022-5223/$36.00 Copyright Ó 2014 Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery http://dx.doi.org/10.1016/j.jtcvs.2014.07.068
diagnosis and management of AAD.1,6,8-19 However, most patients included in the IRAD are from developed countries withadvanced medical care. Thus, the datafromthe IRAD will not reflect the current reality of patients with AAD in China. To better understand the clinical features of AAD in Chinese population,achievepossibleimprovementsinitsdiagnosisand treatment, and be able to systematically com-pare the current situation of AAD domestically and abroad, it was urgent to establisharegistryofaorticdissectioninChina. Therefore, we established the first Registry of Aortic Dissection in China (Sino-RAD). Then, the 1003 patients with AAD included in the Sino-RAD were evaluated and compared with the data reported by IRAD. A preliminary investigation of the differences between the patients included in Sino-RAD and those included in IRAD could provide potentially useful insights into further understanding of the disease for cardiovascular disease scientists. METHODS Establishment of the Sino-RAD In 2011, the establishment of the first Registry of Aortic Dissection in China (available at: www.Sino-RAD.com) was led by the Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University. Another 14 large cardiovascular centers in China are also participating in the registry. The centers cover most of the east and midland of China.
Patient Selection All patients with AAD were enrolled from January 1, 2012, to December 31, 2013. The diagnosis was determined from the history,
The Journal of Thoracic and Cardiovascular Surgery c Volume 148, Number 6
2995
ACD
Conclusions: The first Sino-RAD, including 15 large cardiovascular centers throughout China, was established. Our data were compared with those reported by IRAD. We found that, compared with Western populations, Chinese patients with AAD showed 6 differences, including earlier onset, more male patients, a low incidence of hypertension, a low incidence of chest pain, a high incidence of back pain, great differences in the choice of therapeutic strategies, and relatively low in-hospital mortality. (J Thorac Cardiovasc Surg 2014;148:2995-3000)
Acquired Cardiovascular Disease
Abbreviations and Acronyms AAD ¼ acute aortic dissection IRAD ¼ International Registry of Acute Aortic Dissection Sino-RAD ¼ Registry of Aortic Dissection in China physical examination findings, imaging study findings, visualization at surgery, and/or postmortem examination. Patients with aortic disruption secondary to trauma were excluded.
Data Collection A questionnaire, defined according to standard definitions, including demographic data, history, physical findings, management, imaging studies, and outcomes, was developed. The acute stage was confined to the initial 14 days after symptom onset. Data were collected at presentation or by physician review of the hospital records and were forwarded to the Sino-RAD Coordinating Center at the Fourth Military Medical University. The forms were reviewed for clinical face validity and analytical internal validity. The IRAD data were taken from reports published publicly in 2000,1 2004,20 and 2007.21
Statistical Analysis Categorical data are presented as frequencies and percentages and continuous data as the mean standard deviation. The continuous variables were compared using the Student t test for normal distributions and the Mann-Whitney U test for non-normal distributions. The categorical variables were compared using the chi-square test or Fisher’s exact test, as appropriate. Data analysis was performed using the Statistical Package for Social Sciences, version 18.0 (SPSS, Chicago, Ill).
ACD
RESULTS Demographic Data A total of 1003 patients with AAD were enrolled in SinoRAD (Table 1). Compared with IRAD, the patients with AAD in Sino-RAD were significantly younger (P
