• Am. J. Med. · Oct 2013

    Multicenter Study Comparative Study

    Acute aortic dissection in blacks: insights from the International Registry of Acute Aortic Dissection.

    • Eduardo Bossone, Reed E Pyeritz, Patrick O'Gara, Kevin M Harris, Alan C Braverman, Linda Pape, Mark J Russo, G Chad Hughes, Thomas T Tsai, Daniel G Montgomery, Christoph A Nienaber, Eric M Isselbacher, Kim A Eagle, and International Registry of Acute Aortic Dissection (IRAD) Investigators.
    • Heart Department, University Hospital, Salerno, Italy. Electronic address: ebossone@hotmail.com.
    • Am. J. Med. 2013 Oct 1; 126 (10): 909915909-15.

    BackgroundFew data exist on race-related differences in acute aortic dissection patients.MethodsWe 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.ResultsType 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 <.001) and more likely to have a history of cocaine abuse (12% vs 1.6%, P <.001), hypertension (89.7% vs 73.9%, P <.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 <.001) and left ventricular hypertrophy on echocardiogram (44.2% vs 20.1%, P <.001) in blacks. Management was similar. Hypotension/shock/tamponade was less common (7.6% vs 20.1%, P <.001), whereas acute kidney failure was more common (41.0% vs 21.7%, P <.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).ConclusionsOur study shows differences in type, etiology, and presentation of blacks and whites with acute aortic dissection, yet similar mortality for these cohorts.Copyright © 2013 Elsevier Inc. All rights reserved.

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