Evaluating current acute aortic syndrome pathways: Collaborative Acute Aortic Syndrome Project (CAASP)
Authors: Zhong Jim , Singh Aminder A , Safdar Nawaz Z , Nandhra Sandip , Vigneswaran Ganesh ,   CAASP Collaborators, Aziz Ishtiaq , Abuduruk Aseel , Abdallah Adel , Stather Philip , Mancuso Enrico , Elsayed Ayman , Wallace Tom , Laloo Ryan , Tang Steve , Aimar Kelsey , Aufi Ahmed Al , Zhong Jim , Poon Choong , Tham Jun-Li , Leong Weii Jsim , Khalil Ahmed , Taha Mohamed , Ravindhran Bharadhwaj , Igwe Chukwuemeka , Plevneshi Elio , Altarqane Mustafa , Bosanquet David C , Oo Khaing Khant , Gwilym Brenig , Azooz Syfe , Niina Ayako , Mandal Indrajeet , Varghese Abin , Stephanou Michael , Ghaffari Ehsan , Uberoi Raman , Harborne Katrina , Walker Samuel , Nasir Faizan , Horne Niamh , Alam Benyamin , Christie Andrew , Watkins Linda , Cuthbertson Rebecca , Lenart Lucia , Chaudhary Neera , Khalid Alisa , Makar Ragai R , Khallaf Andrew I , Francis Chris T , Zaki Shady , Shehata Ramez , Al-Kassar Anwar , Musto Liam , Dattani Nikesh , Lopez-Penna Gabriel , Houghton John S M , Pettit Mathew , Budge James , Selway William , Farquharson Barnaby , Desai Mital , Mcalinden Jack , Tripathi Kriti , Kobe Isaac , Kannan Ramesh , Slee Charlotte , Munshi Reema , Boppana Sriram Kumar , Wunnava Sai , Woodmass Michael , Griffith Caitlin Nessa , Dalton Alexandra Rachel Beth , Shahin Yousef , Burrows Victoria , Ehsan Saima , Kang Joe , Tan Joni , Geh Thomas , Maclean Drew , Chatterjee Sohini , Ogunjinmi Bukola , Pearson Marina , Kotecha Deevia , Dattani Nikesh , Benson Ruth , Blair Robert , Patel Shian , Shalhoub Joseph , Shiwani Hunain , Som Avik , Sun Ginny , Khashram Manar , Cooper Graham , Sanders Julie , Scott Philip , Wilson Sarah , Williams Robin , Walker Paul , Jackson Phil , Bromley Mathew , Ambler Graeme , Birmpili Panagiota , Hitchman Louise , Hurndall Katherine , Onida Sarah , Saratzis Athanasios , Al-Saadi Nina , Shelmerdine Lauren 
Published: September 2024

Abstract

Background
Diagnosis of acute aortic syndrome is challenging and associated with high perihospital mortality rates. The study aim was to evaluate current pathways and understand the chronology of acute aortic syndrome patient care.

Method
Consecutive patients with acute aortic syndrome imaging diagnosis between 1 January 2018 and 1 June 2021 were identified using a predetermined search strategy and followed up for 6 months through retrospective case note review. The UK National Interventional Radiology Trainee Research and Vascular and Endovascular Research Network co-ordinated the study.

Results
From 15 UK sites, 620 patients were enrolled. The median age was 67 (range 25–98) years, 62.0% were male and 92.9% Caucasian. Type-A dissection (41.8%) was most common, followed by type-B (34.5%); 41.2% had complicated acute aortic syndrome. Mode of presentation included emergency ambulance (80.2%), self-presentation (16.2%), and primary care referral (3.6%). Time (median (i.q.r.)) to hospital presentation was 3.1 (1.8–8.6) h and decreased by sudden onset chest pain but increased with migratory pain or hypertension. Time from hospital presentation to imaging diagnosis was 3.2 (1.3–6.5) h and increased by family history of aortic disease and decreased by concurrent ischaemic limb. Time from diagnosis to treatment was 2 (1.0–4.3) h with interhospital transfer causing delay. Management included conservative (60.2%), open surgery (32.2%), endovascular (4.8%), hybrid (1.4%) and palliative (1.4%). Factors associated with a higher mortality rate at 30 days and 6 months were acute aortic syndrome type, complicated disease, no critical care admission and age more than 70 years (P &lt; 0.05).

Conclusions
This study presents a longitudinal data set linking time-based delays to diagnosis and treatment with clinical outcomes. It can be used to prioritize research strategies to streamline patient care.