Characterizing the young patient with aortic dissection: Results from the international registry of aortic dissection (IRAD)

OBJECTIVES The goal of this study was to better characterize the young patient with aortic dissection (AoD). BACKGROUND Aortic dissection is unusual in young patients, and frequently associated with unusual presentations. METHODS Data were collected on 951 patients diagnosed with AoD between January 1996 and November 2001. Two categories of patients, <40 years and 40 years, were compared using chi-square cross tabulations for categorical and Student t test for continuous data. RESULTS Sixty-eight patients (7%) with AoD were <40 years of age. Compared with patients greater than or equal to40 years, younger patients were less likely to have a prior history of hypertension (p < 0.05); however, younger patients were more likely to have Marfan syndrome, bicuspid aortic valve, and prior aortic surgery (all, p < 0.05). Clinical presentations in the two age groups were similar; however, younger patients were less likely to be hypertensive (25% vs. 45%, p = 0.003). The proximal aortas of young AoD patients were larger (all, p < 0.05) compared with older patients. These differences in aortic size between age groups were not entirely related to Marfan syndrome. Mortality among young patients was similar to patients greater than or equal to40 years of age (22% vs. 24%, p = NS), irrespective of the site of dissection. CONCLUSIONS Compared with older patients with AoD, young patients have unique risk factors for dissection: Marfan syndrome, bicuspid aortic valves, and larger aortic dimensions. Surprisingly, the mortality risk for young AoD patients is not lower than older AoD patients. (C) 2004 by the American College of Cardiology Foundation.