Clinical presentation, diagnosis, and hospital outcome of patients with documented aortic dissection: The Albany Medical Center Experience, 1986 to 1996

Background In recent years, the diagnostic approach to patients with suspected aortic dissection has changed dramatically. Noninvasive studies such as transesophageal echocardiography (TEE), computed tomography, and magnetic resonance imaging have supplanted angiography as the initial tests of choice. The effect of this change in diagnostic approach has not previously been evaluated. Methods and Results The records of all patients discharged from Albany Medical Center Hospital between January 1, 1986, and December 31, 1996, were screened for an “aortic dissection” entry in the medical record database. For those records in which aortic dissection was confirmed, data concerning the diagnostic evaluation, treatment, and hospital course were recorded and analyzed. During the study period, there were 160 cases of documented aortic dissection discharged from the hospital. There were 100 type A and 60 type B dissections. The most commonly used diagnostic tests were TEE (83 of 160) and angiography (60 of 160). In patients who had TEE, diagnosis was made more quickly but overall mortality rate was not different from patients who had angiography. Renal dysfunction and neurologic events were less frequent in the TEE group. Hospital stay was significantly shorter in the TEE group (24.8 ± 3.9 vs 14.0 ± 1.8 days, P = .01). Conclusions The use of TEE reduces morbidity rate and hospital stay in patients with aortic dissection but does not affect mortality rate. (Am Heart J 1999;137:154-61.)