Impact of age-related arterial degeneration and inflammation on the presentation and etiopathogenesis of acute aortic syndrome
Authors: Ferrer M , Altadill F , Tabilo J F , Barros A J 
Published: May 2024

Abstract

Funding Acknowledgements
None.

Background
Acute aortic syndrome (AAS) is a critical cardiovascular emergency marked by substantial morbidity and mortality. Both its presentation and accompanying comorbidities hold considerable prognostic and therapeutic implications. Recent observations suggest an age-related increase in the incidence of AAS due to population aging. Nonetheless, the etiopathogenic distinctions between various presentation forms and their connection with age remain enigmatic.

Purpose
To delineate the forms of presentation of AAS and examine the epidemiological variables according to age, as well as its correlation with the presence of degenerative or inflammatory radiological signs.

Methods
We analyzed the data from a prospective registry that included all patients with AAS treated at our centre, from 2012 to 2022. The study population was stratified in three age groups: &lt;70 years, 70-80 years and &gt;80 years Three forms of AAS presentation were defined: acute aortic dissection (AAD), intramural hematoma (IMH) and penetrating atherosclerotic ulcer (PAU). AAS extension was defined by Stanford classification. Degenerative or inflammatory radiological signs were defined as thickening or calcification in the wall of any segment of the aorta or in any of the main arterial territories, regardless of the degree of stenosis.

Results
256 patients were included. 156 were &lt;70 years, 63 were 70-80 years, and 37 were &gt;80 years. 195 (76%) had an AAD, 42 (16%) an IMH, 12 (5%) a PAU and 7 (3%) could not be classified. 181 (71%) were type A. AAD were significantly younger than the rest of AAS (61±14 vs 73±10, p&lt;0.0001). Type B AAS occurred at older ages (67±13 vs 63±14, p 0.03). 87% of AAS in patients &lt;70 years were AAD while IMH and PAU increased significantly with age. Active smoking and history of Marfan syndrome were more prevalent in the &lt;70-year-old group. Patients &gt;70 years had more COPD, ischemic heart disease, previous stroke, aortic aneurysm, non-bicuspid aortic valve disease, history of cardiac catheterization and antiplatelet and anticoagulant treatment. Atherosclerotic/inflammatory changes in the aortic wall were present in 46% of AAD versus 63% in the rest of AAS (p 0.068) and in 43% of AAS type A versus 67% of type B (p 0.005). Age was significantly associated with atherosclerotic/inflammatory changes (35% in &lt;70 years, 78% in 70-80 years and 73% in &gt;80 years, p &lt;0.0001) as well as with thickening/calcification of the coronary arteries and the main arterial trunks. See table for more details.

Conclusions
Age represents a change in trends in terms of the forms of presentation of AAS. AAD are significantly more prevalent in younger patients than the rest of AAS and type B occurs at later ages. Elderly patients are more likely to present IMH and PAU, in percentage detriment of AAD. These epidemiological differences and radiological findings are related to atherosclerotic/inflammatory changes that increase with age, which could justify these findings.Table 1.Representation of the data.