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Charlene Gaca

Bio: Charlene Gaca is an academic researcher. The author has contributed to research in topics: Mortality rate & Irad. The author has an hindex of 1, co-authored 1 publications receiving 2793 citations.

Topics: Mortality rate, Irad, Aortic dissection, Acute aortic syndrome ...read more

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The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease.

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Peter Hagan¹, Christoph A. Nienaber², Eric M. Isselbacher, David Bruckman¹, Dean Karavite¹, P. Russman¹, Arturo Evangelista³, Rossella Fattori⁴, Toru Suzuki⁵, Jae K. Oh⁶, Andrew G. Moore⁶, Joseph F. Malouf⁶, Linda Pape, Charlene Gaca, Udo Sechtem⁷, Suzanne Lenferink⁷, Hans J. Deutsch⁸, Holger Diedrichs⁸, Jose Marcos y Robles⁹, Alfredo Llovet⁹, Dan Gilon, Sugata Das¹, William F. Armstrong¹, G. Michael Deeb¹, Kim A. Eagle¹ - Show less +21 more•Institutions (9)

University of Michigan¹, University of Hamburg², Autonomous University of Barcelona³, University of Bologna⁴, University of Tokyo⁵, Mayo Clinic⁶, Bosch⁷, University of Cologne⁸, Complutense University of Madrid⁹

16 Feb 2000-JAMA

TL;DR: The data support the need for continued improvement in prevention, diagnosis, and management of acute aortic dissection and suggest a high clinical index of suspicion is necessary.

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Abstract: ContextAcute aortic dissection is a life-threatening medical emergency associated with high rates of morbidity and mortality. Data are limited regarding the effect of recent imaging and therapeutic advances on patient care and outcomes in this setting.ObjectiveTo assess the presentation, management, and outcomes of acute aortic dissection.DesignCase series with patients enrolled between January 1996 and December 1998. Data were collected at presentation and by physician review of hospital records.SettingThe International Registry of Acute Aortic Dissection, consisting of 12 international referral centers.ParticipantsA total of 464 patients (mean age, 63 years; 65.3% male), 62.3% of whom had type A dissection.Main Outcome MeasuresPresenting history, physical findings, management, and mortality, as assessed by history and physician review of hospital records.ResultsWhile sudden onset of severe sharp pain was the single most common presenting complaint, the clinical presentation was diverse. Classic physical findings such as aortic regurgitation and pulse deficit were noted in only 31.6% and 15.1% of patients, respectively, and initial chest radiograph and electrocardiogram were frequently not helpful (no abnormalities were noted in 12.4% and 31.3% of patients, respectively). Computed tomography was the initial imaging modality used in 61.1%. Overall in-hospital mortality was 27.4%. Mortality of patients with type A dissection managed surgically was 26%; among those not receiving surgery (typically because of advanced age and comorbidity), mortality was 58%. Mortality of patients with type B dissection treated medically was 10.7%. Surgery was performed in 20% of patients with type B dissection; mortality in this group was 31.4%.ConclusionsAcute aortic dissection presents with a wide range of manifestations, and classic findings are often absent. A high clinical index of suspicion is necessary. Despite recent advances, in-hospital mortality rates remain high. Our data support the need for continued improvement in prevention, diagnosis, and management of acute aortic dissection.

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Charlene Gaca

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