The incidence and mortality of acute thoracic aortic dissection: results from a whole nation study

Eur J Cardiothorac Surg. 2016 Dec;50(6):1111-1117. doi: 10.1093/ejcts/ezw235. Epub 2016 Jun 22.


Objectives: Acute thoracic aortic dissection (ATAD) is a devastating condition associated with a high mortality rate. Recent reports suggest that its incidence is rising. Utilizing nationwide data comprising the whole Icelandic population, we aimed to determine the incidence, mortality rate and time-dependent mortality risk of ATAD.

Methods: Data were retrospectively collected using centralized hospital discharge registries, autopsy records and Cause of Death Registry in Iceland from 1992 to 2013.

Results: Age- and gender-adjusted incidence of ATAD was 2.53/100 000/year, and no significant change in incidence was observed during the study period. The mean age was 66.9 ± 13.6 years and 66.0% (101/153) were Stanford type A. Of the whole group, 17.6% (27/153) died prior to hospital arrival, whereas the risk of death for patients who arrived alive to a hospital was 21.4% (27/126) within 24 h and 45.2% (57/126) at 30 days. During the course of the study, patients with type A dissection were more likely to undergo an operation and the management of type B dissection changed from open to endovascular repair. The 30-day mortality rate declined every year and the 5-year survival rate improved in the last third of the study.

Conclusions: The incidence of ATAD was 2.53/100 000/year and remained constant throughout the study, contradicting recent perceptions of a rising incidence. ATAD, type A in particular, remains a highly lethal condition: Over half of all patients die within 30 days of the index event. A reduced 30-day mortality rate and an increased long-term survival rate indicate improved overall outcomes in patients with this complex condition.

Keywords: Aortic dissection; Aortic surgery; Epidemiology; Population studies.

MeSH terms

  • Age Factors
  • Aged
  • Aortic Aneurysm, Thoracic / epidemiology*
  • Aortic Aneurysm, Thoracic / mortality
  • Aortic Aneurysm, Thoracic / surgery
  • Aortic Dissection / epidemiology*
  • Aortic Dissection / mortality
  • Aortic Dissection / surgery
  • Female
  • Humans
  • Incidence
  • Ireland / epidemiology
  • Kaplan-Meier Estimate
  • Male
  • Proportional Hazards Models
  • Retrospective Studies
  • Sex Factors
  • Survival Analysis