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Open Access Research article

Treatment patterns and their outcomes of acute aortic intramural hematoma in real world: multicenter registry for aortic intramural hematoma

Yoon-Jung Choi1, Jang-Won Son1, Sang-Hee Lee1, Ung Kim1, Dong-Gu Shin1, Young-Jo Kim1, Seung-Ho Hur2, Chang-Wook Nam2, Yun-Kyeong Cho2, Bong-Ryul Lee3, Byung-Chun Jeong3, Jin-Bae Lee4, Jae-Kean Ryu4, Hun-Sik Park5, Jang-Hoon Lee5, Se-Yong Jang5 and Jong-Seon Park1*

Author Affiliations

1 Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, 170, Hyeonchung-ro, Nam-gu, Daegu 705-717, Republic of Korea

2 Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, 56, Dalsung-ro, Jung-gu, Daegu 700-712, Republic of Korea

3 Division of Cardiology, Department of Internal Medicine, Daegu Fatima Hospital, 99, Ayang-ro, Dong-gu, Daegu 701-724, Republic of Korea

4 Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, 17, Duryugongwon-ro, Nam-gu, Daegu 705-718, Republic of Korea

5 Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, 130, Dongduk-ro, Jung-gu, Daegu 700-721, Republic of Korea

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BMC Cardiovascular Disorders 2014, 14:103  doi:10.1186/1471-2261-14-103

Published: 19 August 2014

Abstract

Background

Intramural hematoma of the aorta (IMH), a variant of classic aortic dissection, shows very dynamic process in the early phase. The aim of this study is to evaluate clinical outcomes of patients with acute aortic IMH from real world registry data.

Methods

We analyzed 165 consecutive patients with acute IMH from five medical centers in Korea. All patients were divided into two groups; type A (n = 61, 37.0%) and type B (n = 104, 63.0%) according to the Stanford classification. Clinical outcomes and morphological evolution by CT were analyzed for 2 years.

Results

Most of the patients (77.0% of type A and 99.0% of type B, P < 0.001) were treated medically during their initial hospitalization. There were no significant differences in in-hospital mortality (4.9% vs. 2.9%, P = 0.671) and 2-year mortality (13.1% vs. 11.5%, P = 0.765) between two groups. During the 2-year follow up period, progression to aortic dissection (18.0% vs. 6.7%, P = 0.037) and surgical treatment (29.5% vs. 2.9%, P < 0.001) were higher in type A. For the type A patients, there were no significant difference in in-hospital mortality (7.1% of surgery vs. 4.3% of medical, P = 0.428) and 2-year mortality (7.1% of surgery vs. 14.9% of medical, P = 0.450) in terms of initial treatment strategy.

Conclusion

For real world practice in Korea, most of IMH patients were treated medically at presentation and showed favorable outcomes. Thus, even in type A acute IMH, early medical treatment with alternative surgical conversion for selected, complicated cases would be a favorable treatment option.

Keywords:
Intramural hematoma of the aorta; Survival rates; Treatment