American Journal of Cardiology
Volume 102, Issue 10 , Pages 1399-1406 , 15 November 2008

Risk Factors for Diagnostic Delay in Acute Aortic Dissection

  • Claudio Rapezzi, MD

      Affiliations

    • Institute of Cardiology, University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
    • Corresponding Author InformationCorresponding author: Tel: 39-051-636-4483; fax: 39-051-344-859
    • ,
  • Simone Longhi, MD

      Affiliations

    • Institute of Cardiology, University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
    • ,
  • Maddalena Graziosi, MD

      Affiliations

    • Institute of Cardiology, University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
    • ,
  • Elena Biagini, MD, PhD

      Affiliations

    • Institute of Cardiology, University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
    • ,
  • Francesca Terzi, MD

      Affiliations

    • Institute of Cardiology, University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
    • ,
  • Robin M.T. Cooke, MA

      Affiliations

    • Institute of Cardiology, University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
    • ,
  • Cristina Quarta, MD

      Affiliations

    • Institute of Cardiology, University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
    • ,
  • Diego Sangiorgi, MStat

      Affiliations

    • Institute of Cardiology, University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
    • ,
  • Paolo Ciliberti, MD

      Affiliations

    • Institute of Cardiology, University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
    • ,
  • Giuseppe Di Pasquale, MD

      Affiliations

    • Division of Cardiology, Maggiore Hospital, Bologna, Italy
    • ,
  • Angelo Branzi, MD

      Affiliations

    • Institute of Cardiology, University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy

Received 16 May 2008 ,Revised 13 July 2008 ,Accepted 13 July 2008.

References 

  1. Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, et al The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 2000;283:897–903
  2. Collins JS, Evangelista A, Nienaber CA, Bossone E, Fang J, Cooper JV, et al International Registry of Aortic Dissection (IRAD) (Differences in clinical presentation, management, and outcomes of acute type a aortic dissection in patients with and without previous cardiac surgery). Circulation. 2004;110:237–242
  3. Suzuki T, Mehta RH, Ince H, Nagai R, Sakomura Y, Weber F, et al International Registry of Aortic Dissection (IRAD) (Clinical profiles and outcomes of acute type B aortic dissection in the current era: lessons from the International Registry of Aortic Dissection (IRAD)). Circulation. 2003;108:312–317
  4. Bossone E, Rampoldi V, Nienaber CA, Trimarchi S, Ballotta A, Cooper JV, et al. International Registry of Acute Aortic Dissection (IRAD) Investigators (Usefulness of pulse deficit to predict in-hospital complications and mortality in patients with acute type A aortic dissection). Am J Cardiol. 2002;89:851–855
  5. Jannuzzi JL, Isselbacher EM, Fattori R, Cooper JV, Smith DE, Fang J, et al. International Registry of Aortic Dissection (IRAD) (Characterizing the young patient with aortic dissection: results from the International Registry of Aortic Dissection (IRAD)). J Am Coll Cardiol. 2004;43:665–669
  6. Nienaber CA, Eagle KA. Aortic dissection: new frontiers in diagnosis and management part I: from etiology to diagnostic strategies. Circulation. 2003;108:628–635
  7. Klompas M. Does this patient have an acute thoracic aortic dissection?. JAMA. 2002;287:2262–2272
  8. Hansen MS, Nogareda GJ, Hutchison SJ. Frequency of and inappropriate treatment of misdiagnosis of acute aortic dissection. Hansen MS, Nogareda GJ, Hutchison SJ Am J Cardiol. 2007;99:852–856
  9. Flemming KD, Brown RD. Acute cerebral infarction caused by aortic dissection: caution in the thrombolytic era. Stroke. 1999;30:477–478
  10. Nallamothu BK, Mehta RH, Saint S, Llovet A, Bossone E, Cooper JV, et al. Syncope in acute aortic dissection: diagnostic, prognostic, and clinical implications. Am J Med. 2002;113:468–471
  11. Spittell PC, Spittell JA, Joice JW, Tajik AJ, Edwards WD, Schaff HV, et al. Clinical features and differential diagnosis of aortic dissection: experience with 236 cases (1980 through 1990). Mayo Clinic Proc. 1993;68:642–651
  12. Bassand JP, Hamm CW, Ardissino D, Boersma E, Budaj A, Fernandez-Aviles F, et al. Guidelines for the diagnosis and treatment of non–ST-segment elevation acute coronary syndromes (The task force for the diagnosis and treatment of non–ST-segment elevation acute coronary syndromes of the European Society of Cardiology). Eur Heart J. 2007;28:1598–1660
  13. Van de Werf F, Ardissino D, Betriu A, Cokkinos DV, Falk E, Fox KAA, et al Management of acute myocardial infarction in patients presenting with ST-segment elevation (The task force on the management of acute myocardial infarction of the European Society of Cardiology). Eur Heart J. 2003;24:28–66
  14. Hollenberg SM, Kavinsky CJ, Parrillo JE. Cardiogenic shock. Ann Intern Med. 1999;131:47–59
  15. Spodick DH. Acute cardiac tamponade. N Engl J Med. 2003;349:684–690
  16. Evangelista A, Mukherjee D, Mehta RH, O'Gara PT, Fattori R, Cooper JV, et al International Registry of Aortic Dissection (IRAD) Investigator (Acute intramural hematoma of the aorta: a mystery in evolution). Circulation. 2005;111:1063–1070
  17. Isselbacher EM. Aortic disease. In:  Zipes DP,  Libby P,  Bonow RO,  Braunwald E editor. Braunwald's Heart Disease. 7th Ed.. Philadelphia: Elsevier-Masson; 2005;p. 1403–1435
  18. Ortolani P, Marzocchi A, Marrozzini C, Palmerini T, Saia F, Serantoni C, et al Clinical impact of direct referral to primary percutaneous coronary intervention following pre-hospital diagnosis of ST-elevation myocardial infarction. Eur Heart J. 2006;27:1515–1516
  19. Ortolani P, Marzocchi A, Marrozzini C, Palmerini T, Saia F, Baldazzi F, et al Usefulness of prehospital triage in patients with cardiogenic shock complicating ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Am J Cardiol. 2007;100:787–792
  20. GISSI Investigators. Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction (Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico (GISSI)). Lancet. 1986;1:397–402
  21. GISSI Avoidable Delay Study Group. Epidemiology of avoidable delay in the care of patients with acute myocardial infarction in Italy (A GISSI-generated study). Arch Intern Med. 1995;155:1481–1488
  22. Shinohara T, Suzuki K, Okada M, Shiigai M, Shimizu M, Maehara T, et al. Soluble elastin fragments in serum are elevated in acute aortic dissection. Arterioscler Thromb Vasc Biol. 2003;23:1839–1844
  23. Suzuki K, Katoh H, Watanabe M, Kurabayashi M, Hiramori K, Hori S, et al Novel biochemical diagnostic method for aortic dissection (Results of a prospective study using an immunoassay of smooth muscle myosin heavy chain). Circulation. 1996;93:1244–1249
  24. Sangiorgi G, Trimarchi S, Mauriello A, Righini P, Bossone E, Suzuki T, et al. Plasma levels of metalloproteinases-9 and -2 in the acute and subacute phases of type A and type B aortic dissection. J Cardiovasc Med (Hagerstown). 2006;7:307–315
  25. Biagini E, Lofiego C, Ferlito M, Fattori R, Rocchi G, Graziosi M, et al Frequency, determinants, and clinical relevance of acute coronary syndrome–like electrocardiographic findings in patients with acute aortic syndrome. Am J Cardiol. 2007;100:1013–1019

 The study was supported in part by Fondazione Fanti Melloni (Bologna, Italy), a nonprofit-making foundation dedicated to cardiovascular research.

PII: S0002-9149(08)01216-2

doi: 10.1016/j.amjcard.2008.07.013

American Journal of Cardiology
Volume 102, Issue 10 , Pages 1399-1406 , 15 November 2008

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