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

Inga H. Melvinsdottir, Sigrun H. Lund, Bjarni A. Agnarsson, Kristinn Sigvaldason, Tomas Gudbjartsson, Arnar Geirsson*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

70 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)1111-1117
Number of pages7
JournalEuropean Journal of Cardio-thoracic Surgery
Issue number6
Publication statusPublished - Dec 2016

Bibliographical note

Publisher Copyright:
© The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Other keywords

  • Aortic dissection
  • Aortic surgery
  • Epidemiology
  • Population studies


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