Clinical Characteristics, Incidences, and Mortality Rates for Aortic Dissections Type A and B: A Nationwide Danish Population-Based Cohort Study from 1996 to 2016

Objectives: This study aimed to report clinical characteristics, incidences, and mortality rates for aortic dissections (AD) in Denmark from 1996–2016 stratified by Stanford Classification.

Methods: We conducted a nationwide, population-based, register study. All cases of AD registered in the National Patient Registry with available medical records underwent retrospective validation and was supplemented with data from other Danish health registries (1). For long-term 5-year survival analyses, validated cases of AD were matched 1:10 with hypertonic patients from the general population.

Results: A total of 2,719 cases were validated as AD ([Fig. 1]). Distribution of AD type A (TAAD) and type B (TBAD) was 59.6% and 38.9% (p < 0.001), respectively, and 67.0% and 67.5% were men (p < 0.001), respectively. Mean ages at dissection for TAAD and TBAD were 63.5 ± 12.9 years and 67.5 ± 12.2 years, respectively, and females were 6.5 years (95% CI: 5.2–7.8) and 2.0 years (95% CI: 0.5–3.6) older than males, respectively. The most prevalent comorbidities for TAAD were hypertension (62.7%), thoracic aortic aneurysms (16.6%), and chronic obstructive pulmonary disease (COPD) (14.9%), and for TBAD hypertension (66.7%), aortic aneurysms at any location (8.8–12.4%), and COPD (16.6%). The annual incidence rate was 4.2/100,000 patient-years and increased significantly from 2.9/100,000 (1996–2000) to 5.4/100,000 (2011–2016) (p < 0.001) ([Fig. 2]). The incidence rates were significantly higher for TAAD compared with TBAD. The 30-day mortality rates for TAAD and TBAD were 22.1% and 13.9% (p < 0.001), respectively, with no significant changes in time. Long-term 5-year all-cause mortality rates adjusted for date, sex, and age for TAAD and TBAD were hazard ratio 3.1 (95% CI 2.8–3.4) and hazard ratio 2.1 (95% CI: 1.9–2.4), respectively.

Conclusions: TAAD was more frequent than TBAD and male sex doubled the risk. Hypertension, aortic aneurysms, and COPD were the most prevalent comorbidities. Incidence rates increased significantly over the 20-year study period, while 30-day mortality rates were consistent.

Fig. 1 Flowchart illustrating the validation process of aortic dissections registered in the Danish National Patient Registry from 1996 to 2016 ICD-10 diagnostic codes: Unspecified aortic dissection (DI710), aortic dissection type A (DI710A), aortic dissection type B (DI710B). Abbreviations: AD, aortic dissection; DNPR, Danish National Patient Registry.

Fig. 2 Aortic Dissections (AD) in Denmark from 1996 to 2016: Incidence Rates Incidence rates of aortic dissections in the adult Danish population from 1996 to 2016. The dashed black line represents the accumulated incidence of aortic dissections, the green and yellow dashed lines represent validated cases of aortic dissections type A and type B, respectively, and the red dashed line represents the unvalidated cases of aortic dissections registered in the Danish National Patient Registry.

Reference

1. Obel LM, Lindholt JS, Lasota AN, et al. Aortic dissections in the population-based Danish National Patient Registry from 1996-2016: a validation study. Clin Epidemiol 2022;14:51–58 PubMed

Publikationsverlauf

Artikel online veröffentlicht:
10. Juni 2022