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Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 2000;283(7):897-903. PMID 10685714

One-paragraph summary

Inaugural report of IRAD: 464 consecutive acute aortic dissection patients enrolled 1996–1998 at 12 international referral centers. Mean age 63; 65.3% male; 62.3% type A. Sudden severe sharp pain was the most common presenting complaint, but classic findings were unreliable: aortic regurgitation murmur in 31.6%, pulse deficit in 15.1%, normal chest radiograph in 12.4%, normal ECG in 31.3%. CT was the initial diagnostic modality in 61.1%. Overall in-hospital mortality 27.4%. Type A: 26% mortality with surgery vs 58% without (surgery withheld mainly for age/comorbidity); type B: 10.7% with medical therapy vs 31.4% with surgery (then reserved for complications).

Key findings

  • Dissection presents diversely; absence of classic physical, radiographic, and ECG findings does not exclude it — a high index of suspicion is mandatory.
  • In-hospital mortality remained high in the modern imaging era: 27.4% overall.
  • Management-stratified mortality (type A surgical 26% / medical 58%; type B medical 10.7% / surgical 31.4%) crystallized the Stanford-based treatment rule.
  • Established the demographic profile: mean age 63, two-thirds male, type A predominance (62.3%).

Limitations

  • Referral-center registry: prehospital deaths and never-diagnosed cases invisible — population studies later showed ~49% of type A dissections die before hospital assessment (Howard 2013, PMID 23599348).
  • Non-consecutive global sampling; management reflects 1996–1998 practice (pre-TEVAR).
  • No core-lab imaging adjudication; treatment selection confounds outcome comparisons (surgical vs medical arms are not exchangeable).

Why it matters

IRAD became the field's shared evidence engine: >7,300 patients and 20 years later it documented rising CT diagnosis, near-universal type A surgery, TEVAR's rise in type B, and falling type A mortality (Pape 2015, PMID 26205591; Evangelista 2018, PMID 29685932). Virtually every quantitative statement about dissection presentation, sex differences, size at dissection (the aortic size paradox, Pape 2007, PMID 17709637), malperfusion, and false-lumen prognosis in this knowledge base descends from the registry this paper launched.

Cited by wiki pages

  • overview
  • aortic-dissection