Study and Objectives:
Nearly one third of patients with aortic dissection die outside an institute, mostly suddenly. The history of such non-hospitalized patients is not sufficiently known. Investigation of the natural history of non-hospitalized patients with acute aortic dissection, and reporting on the results.
Design, Setting, and Participants:
In a population of nearly 106,500 persons, we found 85 cases of aortic dissection (45 men and 40 women) during a period of 23 years from 1984 to 2006. They included 60 hospitalized (32 male and 28 female) and 25 non-hospitalized (13 male, 12 female) patients.
Main Outcome Measures:
Clinico-pathological analysis of the 25 non-hospitalized cases. Comparison between hospitalized and non-hospitalized cases and examination of their differences.
The incidence of the 25 non-hospitalized cases observed during 23 years was 1.02/100,000/year. These 25 patients were 38 to 80 years old, on average 63.1 years. The 13 male patients were 40 to 80 years old, on average 63.2 years and the 12 female patients were 38 to 75 years old with an average age of 63.0 years. The average age of non-hospitalized women was less by 10.7 years than the average age of 73.8 years of hospitalized women. The time of the fatalities was within one hour (sudden cardiac death) in 21 patients. Two patients died between 7–9 hours, and further two patients after 10 and 22 hours. The immediate causes of death were hemopericardium and hemothorax in 23 and 2 cases, respectively. Hypertension was a major predisposing factor in 23 cases. Syncope as the initial symptom of dissection and death was known in 14 cases. There were significant differences between non-hospitalized and hospitalized cases relating to death within one hour, syncope, Type II and distal dissections, external ruptures and the ‘silent period’. Sudden cardiac death caused by acute aortic dissection is an independent pathological phenomenon.
Non-hospitalized aortic dissections constitute nearly one third of all cases. Their incidence can be reduced by careful treatment of the risk factors, particularly hypertension, prompt identification of the condition, and immediate referral to an appropriate institute.
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