Nav: Home

Registry helps move aortic dissection care forward

March 18, 2019

What began with a modest hospital grant at the University of Michigan in 1996 is now the world's leading source of data on diagnosis, treatments and outcomes for a rare and dangerous cardiac condition.

On Monday, Kim Eagle, M.D., a director of U-M's Frankel Cardiovascular Center, presented data from 9,000 patients gathered over nearly 25 years by the International Registry of Acute Aortic Dissection, known as IRAD. Only 3 in 100,000 people per year experience aortic dissection, in which the layers of the aorta tear apart, and both early diagnosis and swift treatment are critical.

A dissection often interferes with blood distribution to the rest of the body, risking function of important organs. In the more dangerous type of dissection, type A, about one-third of patients die within the first 24 hours without treatment, and 50 percent die within 48 hours, typically from aortic rupture.

Eagle presented lessons learned from the first quarter-century of IRAD during the featured clinical research session at the 2019 American College of Cardiology Scientific Session. The cardiologist and professor of internal medicine says he's proud to have grown this project into a global effort that is giving investigators, clinicians and surgeons valuable insight on the changes in aortic dissection care.

"Having such a large number of patients in our registry allows us to see what's working in our care plan and what we still need to do," Eagle says. "I think clinicians should be optimistic about the progress, including improved mortality, and they certainly should see the power of centers of excellence banding together to fight this rare condition."

Worldwide teamwork

IRAD brings together 55 active centers around the world, up from 12 when Eagle started it in 1996. Each center shares data on acute aortic dissection diagnosis, treatment, in-hospital mortality and five-year mortality.

Researchers can see trends happening across the world and track improving mortality rates.

"Aortic dissection is a really devastating disease, and we need to keep working together to improve survival and morbidity," Eagle says. "Here at Michigan, we've had unique physicians, surgeons and imagers working in aortic dissection for many years, and as a result of that reputation we were able to create the IRAD effort. The Frankel CVC faculty's outstanding talent and reputation enable us to attract partnerships with such a large number of outstanding aortic centers worldwide."

The IRAD team also provides a hub of credible, current information for patients on the IRAD website, including a listing of aortic dissection centers of excellence.

"This is a disease that should be cared for by centers that treat a lot of them," Eagle says.

IRAD reveals changes in treatments, outcomes

The results from 9,000 patients covered overall data on the condition and specifics for both types of acute aortic dissections: type A, in the ascending aorta, and type B dissections, which occur in the descending aorta.

The data reveal nearly 90 percent of patients experiencing a type A dissection now receive surgical repair. In-hospital mortality is down to 16.3 percent, while surgical mortality is down to 13 percent, in trends mirrored by the improving outcomes at the Frankel CVC, Eagle says.

Five-year survival remains around 85 percent for both types of dissection.

For patients experiencing a type B dissection, nearly a third now receive endovascular therapy instead of open surgery. In-hospital mortality rates for type B are now 7.4 percent.

In addition, Eagle reported the most common risk factors overall are hypertension, smoking and atherosclerosis.

The second 25 years

Eagle concluded his ACC presentation with an important reminder: There is still a long way to go.

"We still see significant delays in getting diagnoses, and clinicians must tell a lot of our patients that we don't understand the underlying cause of their aortic dissection. Many patients don't have other risk factors beyond hypertension," Eagle says.

Additionally, he says, many patients' aortas dissect at a smaller size than what's recommended for prophylactic repair.

Eagle envisions exponential progress as the second 25 years of IRAD get underway.

"I believe we'll have much better acute diagnostics using biomarkers, a much more complete genetic library to identify patients who might be at risk and a switch to endovascular techniques for most patients rather than open surgeries," he says.

"It's all dependent on continued commitment from the key partners in the IRAD journey: skilled providers taking great care of our dissection patients, large numbers of centers adding to our knowledge and understanding, dedicated supporters including families, donors and industry, who allow us to keep doing the work, and, most importantly, the patients who give a voice to their disease by consenting for research."
-end-


Michigan Medicine - University of Michigan

Related Risk Factors Articles:

Too little sleep may raise death risk in people with cluster of heart disease risk factors
Sleeping less than six hours was associated with higher risk of death in people with metabolic syndrome, a cluster of several heart disease and diabetes risk factors.
New risk factors for anxiety disorders
Several newly discovered variants of a gene increase the risk of developing anxiety disorders.
Alcohol abuse increases risk of heart conditions as much as other risk factors
Alcohol abuse increases the risk of atrial fibrillation, heart attack and congestive heart failure as much as other well-established risk factors such as high blood pressure, diabetes, smoking and obesity, according to a study published today in the Journal of the American College of Cardiology.
Preventing heart failure risk factors in midlife substantially lowers risk
Preventing the development of hypertension, obesity and diabetes by the age of 45 to 55 years may lead up to an 86 percent lower risk for heart failure through the remainder of life, according to research published today in JACC: Heart Failure.
Knowing risk factors could help catch melanomas
University of Sydney researchers and their collaborators have pinpointed risk factors that could help doctors tailor individuals' skin examinations and catch melanoma at an early stage.
Ranking global risk factors for childhood stunting
The leading risk factor for childhood stunting is being born at term but small for gestational age, according to a 137-country analysis published in PLOS Medicine.
Severe lead poisoning in children: Causes and risk factors
Although national and local policies have reduced the prevalence of lead poisoning in the United States, severe cases still occur.
Perinatal risk factors linked with higher risk of obsessive compulsive disorder
A range of perinatal factors appear to be associated with higher risk for children later developing obsessive compulsive disorder, according to an article published online by JAMA Psychiatry.
Study examines risk, risk factors for depression after stroke
During the first three months after stroke, the risk for depression was eight times higher than in a reference population of people without stroke, according to an article published online by JAMA Psychiatry.

Related Risk Factors Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Digital Manipulation
Technology has reshaped our lives in amazing ways. But at what cost? This hour, TED speakers reveal how what we see, read, believe — even how we vote — can be manipulated by the technology we use. Guests include journalist Carole Cadwalladr, consumer advocate Finn Myrstad, writer and marketing professor Scott Galloway, behavioral designer Nir Eyal, and computer graphics researcher Doug Roble.
Now Playing: Science for the People

#529 Do You Really Want to Find Out Who's Your Daddy?
At least some of you by now have probably spit into a tube and mailed it off to find out who your closest relatives are, where you might be from, and what terrible diseases might await you. But what exactly did you find out? And what did you give away? In this live panel at Awesome Con we bring in science writer Tina Saey to talk about all her DNA testing, and bioethicist Debra Mathews, to determine whether Tina should have done it at all. Related links: What FamilyTreeDNA sharing genetic data with police means for you Crime solvers embraced...