Acute Aortic Dissection in Blacks: Insights from the International Registry of Acute Aortic Dissection

作者：Bossone Eduardo^*; Pyeritz Reed E; O' Gara Patrick; Harris Kevin M; Braverman Alan C; Pape Linda; Russo Mark J; Hughes G Chad; Tsai Thomas T; Montgomery Daniel G; Nienaber Christoph A; Isselbacher Eric M; Eagle Kim A

来源：American Journal of Medicine, 2013, 126(10): 909-915.

DOI：10.1016/j.amjmed.2013.04.020

• Aorta
• Epidemiology
• Mortality

BACKGROUND: Few data exist on race-related differences in acute aortic dissection patients. %26lt;br%26gt;METHODS: We evaluated black (n = 189, 14%) or white (n = 1165, 86%) patients (mean age 62.8 +/- 15.3 years; 36.4% women) enrolled in 13 US centers participating in the International Registry of Acute Aortic Dissection. We excluded patients of other racial descent. %26lt;br%26gt;RESULTS: Type B acute aortic dissection was more frequent in the black cohort (52.4% vs 39.3%, P = .001). Black patients were younger (mean age 54.6 +/- 12.8 years vs 64.2 +/- 15.2 years, P %26lt;.001) and more likely to have a history of cocaine abuse (12% vs 1.6%, P %26lt;.001), hypertension (89.7% vs 73.9%, P %26lt;.001), and diabetes (13.2% vs 6.4%, P = .001). Conversely, they were less likely to have bicuspid aortic valve (1.8% vs 5.8%, P = .029), iatrogenic dissection (0.5% vs 4.5%, P = .010), and prior aortic dissection repair (7.7% vs 12.8%, P = .047). Presenting features were similar except for more abdominal pain (44.6% vs 30.6%, P %26lt;.001) and left ventricular hypertrophy on echocardiogram (44.2% vs 20.1%, P %26lt;.001) in blacks. Management was similar. Hypotension/shock/tamponade was less common (7.6% vs 20.1%, P %26lt;.001), whereas acute kidney failure was more common (41.0% vs 21.7%, P %26lt;.001) in blacks. Mortality was similar in-hospital (14.3% vs 19.1%, P = .110, odds ratio 0.704, 95% confidence interval 0.457-1.085) and at 3 years postdischarge, as evaluated by Kaplan-Meier survival analysis (22.0% vs 14.3%, P = .224, SE = 0.062 and 0.018). %26lt;br%26gt;CONCLUSIONS: Our study shows differences in type, etiology, and presentation of blacks and whites with acute aortic dissection, yet similar mortality for these cohorts.

• 出版日期2013-10