Online Table 1. Major scientific articles and clinical findings derived from the IRAD database.
First author, year of
publication
Manuscript Title
Journal
Hagan et al., 2000[1]
The International Registry of Aortic Dissection (IRAD):
New insights into an old disease
JAMA
Mehta et al., 2002[2]
Predicting death in patients with acute type A aortic
dissection
Januzzi et al., 2002[3]
Iatrogenic aortic dissection
The American Journal of
Cardiology
Described the specifics of iatrogenic aortic dissection:
atypical presentation and high mortality, especially for
Type B dissection.
Moore et al., 2002[4]
Choice of computed tomography, transesophageal
echocardiography, magnetic resonance imaging, and
aortography in acute aortic dissection: International
Registry of Acute Aortic Dissection (IRAD)
The American Journal of
Cardiology
Demonstrated high sensitivity for all four imaging
techniques: CT, MRI, TEE, and angiography.
Bossone et al., 2002[5]
Usefulness of pulse deficit to predict in-hospital
complications and mortality in patients with acute type
A aortic dissection
The American Journal of
Cardiology
Showed the effectiveness of pulse deficits in the diagnosis
of acute aortic dissection.
Nallamothu et al., 2002[6]
Syncope in acute aortic dissection: diagnostic,
prognostic, and clinical implications
The American Journal of
Medicine
Identified cardiac tamponade and stroke as significant
predictors of mortality in patients with aortic dissection
presenting with syncope.
Mehta et al., 2002[7]
Acute type A aortic dissection in the elderly: clinical
characteristics, management and outcomes in the current
era
Journal of the American
College of Cardiology
Demonstrated the differences in the clinical
characteristics, management, and hospital outcomes of
aortic dissection in the elderly.
Mehta et al., 2002[8]
Chronobiological patterns of acute aortic dissection
Circulation
Described circadian and seasonal variations in incidence.
Suzuki et al., 2003[9]
Clinical profiles and outcomes of acute type B aortic
dissection– lessons from the International Registry of
Aortic Dissection (IRAD)
Circulation
Established variables associated with increased risk of inhospital mortality among Type B dissection patients to aid
early risk stratification and decision-making.
Januzzi et al., 2004[10]
Characterizing the young patient with aortic dissection:
results from the International Registry of Aortic
Dissection (IRAD)
Circulation
Journal of the American
College of Cardiology
Major Findings
Described manifestations of acute aortic dissection.
Developed a simple risk prediction tool.
Identified the importance of Marfan’s disease, bicuspid
aortic valve, and aortic enlargement in young patients.
1
First author, year of
publication
Manuscript Title
Journal
Major Findings
Mehta et al., 2004[11]
Acute type B aortic dissection in elderly patients:
clinical features, outcomes and simple risk stratification
rule
The Annals of Thoracic
Surgery
Provided a simple decision rule to stratify risk of inhospital death in elderly patients with Type B acute aortic
dissection.
Nienaber et al., 2004[12]
Gender-related differences in acute aortic dissection
Circulation
Described the different clinical features and outcomes in
women with acute aortic dissection.
Januzzi et al., 2004[13]
Comparison of aortic dissection in patients with and
without Marfan's syndrome (results from the
International Registry of Aortic Dissection)
The American Journal of
Cardiology
Park et al., 2004[14]
Association of painless acute aortic dissection with
increased mortality
Mayo Clinic
Proceedings
Demonstrated that aortic dissection can present without
the typical pain and that outcomes in these patients are
less favorable.
Collins et al., 2004[15]
Differences in clinical presentation, management and
outcomes of acute type A aortic dissection in patients
with and without prior cardiac surgery
Circulation
Identified the specifics of aortic dissection in patients with
previous cardiac surgery and showed that, with the
exception of aortic valve replacement, prior cardiac
surgery does not adversely influence early outcomes of
treatment.
Beckman et al., 2004[16]
Branch vessel complications are increased in aortic
dissection patients with renal insufficiency
Vascular Medicine
Demonstrated that routine measurement of serum
creatinine provides a readily accessible clinical marker for
complications of aortic dissection.
Trimarchi et al., 2005[17]
Contemporary results of surgery in acute type A aortic
dissection: the International Registry of Acute Aortic
Dissection experience
The Journal of Thoracic
and Cardiovascular
Surgery
Enumerated the independent preoperative predictors of
operative mortality in patients undergoing surgery for
Type A aortic dissection.
Tsai et al., 2005[18]
Clinical characteristics of hypotension in patients with
acute aortic dissection
The American Journal of
Cardiology
Confirmed that hypotension is a common and highly lethal
complication of acute aortic dissection.
Evangelista et al., 2005[19]
Acute intramural hematoma of the aorta: a mystery in
evolution
Circulation
Established the prevalence of IMH among patients with
aortic dissection and identified IMH of ascending aorta to
be highly lethal.
Upchurch et al., 2005[20]
Acute aortic dissection presenting with primarily
abdominal pain: a rare manifestation of a deadly disease
Annals of Vascular
Surgery
Described the differences and similarities of aortic
dissection in patients with and without Marfan’s
syndrome.
Documented increased mortality in patients with acute
aortic dissection who present primarily with abdominal
pain.
2
First author, year of
publication
Manuscript Title
Journal
Major Findings
Showed that the highest incidence of acute aortic
dissection occurs in the morning time and in the winter
season.
Mehta et al., 2005[21]
Does circadian and seasonal variation in occurrence of
acute aortic dissection influence in-hospital outcomes?
Chronobiology
International
Januzzi et al., 2005[22]
Acute aortic dissection presenting with congestive heart
failure: results from the International Registry of Acute
Aortic Dissection
Journal of the American
College of Cardiology
Described the specifics congestive heart failure as a
potential complication of aortic dissection.
Mukherjee et al., 2005[23]
Implications of periaortic hematoma in patients with
acute aortic dissection (from the International Registry
of Acute Aortic Dissection)
The American Journal of
Cardiology
Demonstrated the importance of early identification and
aggressive management of patients with periaortic
hematomas for improving clinical outcomes.
Trimarchi et al., 2006[24]
Role and results of surgery in acute type B aortic
dissection: insights from the International Registry of
Acute Aortic Dissection (IRAD)
Circulation
Showed that in Type B dissection patients requiring
surgery, use of an open procedure and reduced circulatory
arrest time are correlated with better surgical outcomes.
Henke et al., 2006[25]
Acute limb ischemia associated with type B aortic
dissection: clinical relevance and therapy
Surgery
Demonstrated that acute limb ischemia secondary to aortic
dissection is predictive of death and visceral ischemia.
Tsai et al., 2006[26]
Long-term survival in patients presenting with type A
acute aortic dissection: insights from the International
Registry of Acute Aortic Dissection (IRAD)
Circulation
Presented excellent long-term survival in patients with
Type A aortic dissection treated surgically.
Tsai et al., 2006[27]
Long-term survival in patients presenting with type B
acute aortic dissection: insights from the International
Registry of Acute Aortic Dissection (IRAD)
Circulation
Determined that among Type B dissection survivors the
mortality is high in contemporary follow-up.
Rampoldi et al., 2007[28]
Simple risk models to predict surgical mortality in acute
type A aortic dissection: the International Registry of
Acute Aortic Dissection score
The Annals of Thoracic
Surgery
Devised risk assessment models (predictive scores) for
predicting in-hospital mortality using a multivariable risk
prediction tool.
Acute type B aortic dissection: does aortic arch
involvement affect management and outcomes? Insights
from the International Registry of Acute Aortic
Dissection (IRAD)
Circulation
Demonstrated that acute Type B aortic dissection with and
without arch involvement does not differ with regards to
3-year mortality.
Prognostic role of transesophageal echocardiography in
acute type A aortic dissection.
The American Heart
Journal
Tsai et al., 2007
[29]
Bossone et al., 2007[30]
Studied the prognostic value of transesophageal
echocardiography in medically and surgically treated
patients with acute aortic dissection.
3
First author, year of
publication
Manuscript Title
Tsai et al., 2007[31]
Partial thrombosis of the false lumen in patients with
acute type B aortic dissection
Pape et al., 2007[32]
Aortic diameter >or = 5.5 cm is not a good predictor of
type A aortic dissection: observations from the
International Registry of Acute Aortic Dissection
(IRAD)
Trimarchi et al., 2007[33]
Acute abdominal aortic dissection: insight from the
International Registry of Acute Aortic Dissection
(IRAD).
Fattori et al., 2008
Complicated acute type B dissection: is surgery still the
best option?: a report from the International Registry of
Acute Aortic Dissection
[34]
Journal
Major Findings
The New England
Journal of Medicine
Established partial thrombosis as a predictor of poor postdischarge prognosis.
Circulation
Demonstrated that many dissections occur before accepted
size criteria are achieved.
Journal of Vascular
Surgery
Described the characteristics of isolated abdominal aortic
dissection and recommended aggressive surgical or
endovascular management of such patients.
JACC: Cardiovascular
Interventions
Showed that within the IRAD patient cohort endovascular
treatment seems to provide better in-hospital survival in
patients with a complicated course of acute type B
dissection (compared to open surgery).
Comparing patients from North America and Europe,
showed that in North Americans Type A aortic dissection
occurred at smaller aortic diameters and there was a
substantial delay in presentation and diagnosis.
Raghupathy et al., 2008[35]
Geographic differences in clinical presentation,
treatment, and outcomes in type A acute aortic
dissection (from the International Registry of Acute
Aortic Dissection)
The American Journal of
Cardiology
Suzuki et al., 2008[36]
Preliminary experience with the smooth muscle
Troponin-like protein, Calponin, as a novel biomarker
for diagnosing acute aortic dissection
European Heart Journal
Determined the role of calponin as a potential biomarker
of for early diagnosis of aortic dissection
Gilon et al., 2009[37]
Characteristics and in-hospital outcomes of patients
with cardiac tamponade complicating type A acute
aortic dissection
The American Journal of
Cardiology
Described the outcomes of Type A aortic dissection
complicated by cardiac tamponade, which significantly
worsened survival of these patients.
Suzuki et al., 2009[38]
Diagnosis of acute aortic dissection by D-dimer: the
International Registry of Acute Aortic Dissection
Substudy on Biomarkers (IRAD-Bio) experience
Circulation
Demonstrated the high sensitivity of D-dimer elevation in
detecting aortic dissection.
The Journal of Thoracic
and Cardiovascular
Surgery
Showed that surgical management decreases the inhospital mortality even for octogenarians with Type A
aortic dissection and should be considered in all patients
with type A aortic dissection regardless of age.
Trimarchi et al., 2010
[39]
Trimarchi et al., 2010[40]
Role of age in acute type A aortic dissection outcome:
report from the International Registry of Acute Aortic
Dissection (IRAD)
Importance of refractory pain and hypertension in acute
type B aortic dissection: insights from the International
Registry of Acute Aortic Dissection (IRAD)
Circulation
Described the importance of refractory pain and refractory
hypertension as clinical signs of aortic dissection.
4
First author, year of
publication
Manuscript Title
Journal
Booher et al., 2011[41]
Ascending thoracic aorta dimension and outcomes in
acute type B dissection (from the International Registry
of Acute Aortic Dissection [IRAD])
The American Journal of
Cardiology
Ramanath et al., 2011[42]
The role of preoperative coronary angiography in the
setting of type A acute aortic dissection: insights from
the International Registry of Acute Aortic Dissection
The American Heart
Journal
Rogers et al., 2011[43]
Sensitivity of the aortic dissection detection risk score, a
novel guideline-based tool for identification of acute
aortic dissection at initial presentation: results from the
international registry of acute aortic dissection
Trimarchi et al, 2011[44]
Descending aortic diameter of 5.5 cm or greater is not
an accurate predictor of acute type B aortic dissection
Harris et al., 2011[45]
Correlates of delayed recognition and treatment of acute
type A aortic dissection: the International Registry of
Acute Aortic Dissection (IRAD)
Suzuki et al., 2012[46]
Circulation
Major Findings
Demonstrated that the having a concurrent ascending
aortic aneurysm and Type B aortic dissection does not
predispose to increased risk of mortality.
Determined that coronary angiography preoperatively for
Type A dissection does not alter the in-hospital and longterm mortality.
Identified a high sensitivity of set clinical features for
detecting acute aortic dissection.
The Journal of Thoracic
and Cardiovascular
Surgery
Demonstrated that a significant number of patients with
Type B aortic dissection present with descending aorta
size less than 5.5 cm.
Circulation
Identified the importance of prompt diagnosis (even with
atypical presentation) and referral of aortic dissection
patients in order to improve treatment outcomes.
Type-selective benefits of medications in treatment of
acute aortic dissection (from the International Registry
of Acute Aortic Dissection [IRAD])
The American Journal of
Cardiology
Demonstrated the benefit of β-blockers and lack of benefit
of ACE-inhibitors.
Trimarchi et al, 2012[47]
Influence of clinical presentation on the outcome of
acute B aortic dissection: evidences from IRAD
The Journal of
Cardiovascular Surgery
Showed that uncomplicated acute Type B dissection
patients are best treated with medical therapy, while in
complicated cases endovascular interventions are
associated with better results than open surgery.
Harris et al., 2012[48]
Acute aortic intramural hematoma: an analysis from the
International Registry of Acute Aortic Dissection
Trimarchi et al, 2012[49]
Acute type B aortic dissection in the absence of aortic
dilatation
Jonker et al., 2012[50]
Aortic expansion after acute type B aortic dissection
Circulation
Described the clinical presentation and outcomes of acute
IMH in comparison to classic aortic dissection.
Journal of Vascular
Surgery
Established that female patients of younger age with acute
Type B aortic dissection less commonly present with
aortic dilatation.
The Annals of Thoracic
Surgery
Found that white race and a small initial aortic diameter
were associated with increased aortic expansion in followup, while decreased aortic expansion was observed among
women, patients with IMH, and those on calcium-channel
blockers.
5
First author, year of
publication
Di Eusanio et al., 2013
[51]
Manuscript Title
Clinical presentation, management, and short-term
outcome of patients with type A acute dissection
complicated by mesenteric malperfusion: observations
from the International Registry of Acute Aortic
Dissection
Journal
Major Findings
The Journal of Thoracic
and Cardiovascular
Surgery
Described mesenteric malperfusion as a rare but ominous
complication of acute Type A aortic dissection, carrying a
high risk of hospital mortality, which is improved with
surgical treatment.
Devised a new and more precise classification for
characterizing survival after aortic dissection via 4 distinct
time periods: hyperacute (symptom onset to 24 hours),
acute (2-7 days), subacute (8-30 days), and chronic (>30
days).
Booher et al., 2013[52]
The IRAD classification system for characterizing
survival after aortic dissection
The American Journal of
Medicine
Tolenaar et al., 2013[53]
The differences and similarities between intramural
hematoma of the descending aorta and acute type B
dissection
Journal of Vascular
Surgery
Jonker et al., 2013[54]
The role of age in complicated acute type B aortic
dissection
The Annals of Thoracic
Surgery
Identified advanced age as having a serious impact on the
management and outcomes of patients with complicated
Type B aortic dissection.
Bossone et al., 2013[55]
Acute aortic dissection in blacks: insights from the
International Registry of Acute Aortic Dissection
The American Journal of
Medicine
Found that although there are differences in type, etiology,
and presentation of aortic dissection between blacks and
whites, the mortality rates are the same.
Di Eusanio et al., 2013[56]
Patients with type A acute aortic dissection presenting
with major brain injury: should we operate on them?
The Journal of Thoracic
and Cardiovascular
Surgery
Tolenaar et al., 2013[57]
Painless Type B Aortic Dissection: Insights From the
International Registry of Acute Aortic Dissection
AORTA
Jonker et al., 2014[58]
Acute type B aortic dissection complicated by visceral
ischemia
The Journal of Thoracic
and Cardiovascular
Surgery
Tolenaar et al., 2014[59]
Predicting in-hospital mortality in acute type B aortic
dissection: evidence from International Registry of
Acute Aortic Dissection
Circulation
Provided evidence that patients with acute IMH of the
descending aorta have a slightly more benign course
compared with classic Type B aortic dissection.
Showed that patients with acute Type A aortic dissection
presenting with brain injury demonstrate improved late
survival and frequent reversal of neurologic deficits after
surgical treatment.
Identified a trend for increased in-hospital mortality in
patients with painless acute Type B aortic dissection,
which may be the result of a delay in diagnosis and
management.
Confirmed high mortality rates for patients with Type B
aortic dissection complicated by visceral ischemia, with
surgical and endovascular treatment options providing
better survival than medical management.
Devised a model for predicting in-hospital mortality in
patients with acute type B aortic dissection.
6
First author, year of
publication
Di Eusanio et al., 2014
Dean et al., 2014[61]
[60]
Manuscript Title
Journal
Major Findings
Root replacement surgery versus more conservative
management during type A acute aortic dissection repair
The Annals of Thoracic
Surgery
Found that root replacement surgery in patients with Type
A aortic dissection does not increase hospital mortality
and should be performed in young patients, patients with
connective tissue diseases, and bicuspid aortic valves.
Cocaine-related aortic dissection: lessons from the
International Registry of Acute Aortic Dissection
The American Journal of
Medicine
Called attention to cocaine as an important etiologic factor
for acute aortic dissection in the present era.
*IMH, denotes intramural hematoma
7
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10
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