Aortic dissection: prognosis was poor.

Clinical bottom line (level 4)

  1. Around a sixth of patients with aortic dissection died before surgery.
  2. Only half of patients who had surgery survived for a month.
Chirillo et al: European Heart Journal 1990; 11: 311-319
Expires December 2004

The study

Case series with ?objective ?blinded outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: 11 catheterisation centres, Italy

290 patients (aged mean 58 years, 70% male) aortic dissection diagnosed by angiogram, surgery or autopsy (during 1976-1987)

Excluded if
  • traumatic or iatrogenic causes




    • 94% followed for unclear
    Outcomes studied:
  • died before surgery
  • unfit for surgery
  • death by 30 days after surgery

    • Data was collected via a questionnaire which was divided into four categories: clinical , angiographic, anaesthetic data and information on patient outcome.

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    died before surgery unclear 23/290 7.9%
    (4.8% to 11%)
    unfit for surgery unclear 39/290 13%
    (9.5% to 17%)
    death by 30 days after surgery unclear 101/219 46%
    (40% to 53%)

    • type A: 217 patients (aged 55.1 ± 11); type B: 73 patients (aged 61.1 ± 8)
    • type A/B- classified according to the Stanford type A/B nomenclature based on the presence or absence of involvement of the ascending aorta irrespective of the site of the primary intimal tear and regardless of the extent of distal propagation.
    • Survival from surgery improved over the course of the study.

    Citation

    1. Chirillo F, Marchiori MC, Andriolo L, et al: Outcome of 290 patients with aortic dissection. A 12-year multicentre experience. European Heart Journal 1990; 11: 311-319
    Contributor: Chris Ball and Clare Wotton, December 2000
    Reviewer:

    Clinical Question.
    Patient aortic dissection
    Intervention or Exposure prevalence
    Outcome death