Trends in the clinical profile, management and prognosis of type A aortic syndrome over the last 25 years

Type A acute aortic syndrome (TA-AAS) is associated with high mortality, requiring early diagnosis and urgent surgical treatment.

The aim of this study was to evaluate temporal changes in the clinical profile, management and prognosis of TA-AAS over the past 25 years.

All consecutive patients admitted to the cardiac intensive care unit of a tertiary center between 2000 and 2024 due to TA-AAS were prospectively included. After dividing them into 5-year periods, clinical, diagnostic and therapeutic features, and mortality were analysed.

Among 299 patients included, median age was 63 (53-71) years, 25.8% were women and 85.9% had aortic dissection. Over the study period, admissions due to TA-AAS progressively increased (29 in 2000-2004 vs 116 in 2020-2024), without major changes in baseline characteristics, except for a lower prevalence of peripheral vascular disease (6.9% vs 1.7%, p=0.044) and lower incidence of neurological deficits (37.0% vs 11.5%, p=0.004) and mesenteric ischemia (26.7% vs 2.6%, p<0.001) at presentation. The frequency of dissection decreased (93.1% in 2000-2004 vs 83.5% in 2020-2024) whereas hematomas and ulcerations increased (6.9% in 2000-2004 vs 16.5% in 2020-2024). The use of computed tomography increased from 82.1% to 97.4% (p=0.040), although no earlier diagnosis was achieved (68.8% within the first 12 hours). Surgery was performed in 83.9% of patients, 53.2% within the first 12 hours, without differences over time. Operated patients were younger, more frequently male, and had more moderate/severe aortic regurgitation but lower clinical severity (less shock, tamponade, coma, orotracheal intubation and cardiac arrest), with no other changes over time than a lower incidence of neurological deficits and mesenteric ischemia. Along the study period, in-hospital mortality decreased (44.8% vs 25.0%, p=0.076), both in operated (27.3% vs 16.8%, p=0.291) and non-operated patients (100 vs 61.9%, p=0.028).

Admissions due to TA-AAS have increased over the last 25 years, although clinical profile and treatment remained similar. A decrease in in-hospital mortality was observed in both operated and non-operated patients.

In-hospital mortality of TA-AAS