Acute aortic dissection (AAD) in the elderly.

AAD is a relatively uncommon yet catastrophic disease. Though the relationship between AAD and age has been discussed in several previous studies, many facets of the relationship between AAD and the elderly still remain unclear. From a retrospective review of charts from January 1, 2005 to December 31, 2010, we collected data of 132 spontaneous AAD cases in a medical center in Taiwan, 83 of which were enrolled in our study. We divided patients into two groups: one above 65 years old (elderly), and a second, non-elderly group. Data collected for statistical analysis included: clinical manifestations on arrival, time of onset, type of AAD, width of mediastinum, whether or not the patient underwent an operation, number of days spent hospitalized, and in-hospital mortality rates. We found that in the elderly group there were more instances of hyperglycemia (p=0.0001), more neurologic defects (p=0.001), less chest pain (p=0.001), and less abdominal pain (p=0.003). SBP was also lower in the elderly group (139±48mmHg, p=0.0001), while there was no difference in mediastinal width between these two groups. In both groups, most AAD cases were DeBakey type III, but type I AAD was more commonly seen in the elderly (p=0.0011). We found that there were both lower SBP and higher rate of diabetes in the elderly group. The elderly group also had longer hospital stays (14.6±16.3 days, p=0.0001) and almost twice the mortality rate (31.1% vs. 15.8%, p=0.0001).