888 Incidence Rates of Penn Classes and Class-Specific Mortality in Acute Type an Aortic Dissection Patients: An Epidemiological Systematic Review and Meta-Analysis

Abstract

Abstract Background Acute type A aortic dissection (ATAAD) is a life-threatening emergency which is associated with high morbidity and mortality. One of the complications is end-organ ischemia, a known predictor of mortality. The primary aim of this meta-analysis is to summarise the findings of observational studies investigating the utility of the Penn classification system as well as analyse the incidence rates and mortality patterns within each class. Method Electronic databases PubMed, MEDLINE, and Embase were searched through to April 2023. These were then filtered by multiple reviewers to meet the inclusion criteria. The extracted data included patient characteristics and primary outcomes included incidence rates of different Penn classes, along with the corresponding mortality for each class. Results Out of 1512 studies identified during the initial search, ten studies met the inclusion criteria. Pooled incidence of Penn A was the highest at 0.55 [0.52, 0.58] followed by Penn B at 0.21 [0.17, 0.25], and Penn C at 0.14 [0.11, 0.17]. Patients with both Penn B+C were found to be at the highest risk of death as their mortality rates were 0.36 [0.31, 0.41]. Within those populations, the subtype with the highest individual mortality was Penn C at 0.21 [0.15, 0.27] followed by Penn B at 0.19 [0.15, 0.23] and Penn A at 0.07 [0.05, 0.10]. Conclusions In conclusion, amongst patients presenting with ATAAD, Penn class A was the most frequently observed, followed by classes B, C, and BC. Our findings indicate an incremental increase in mortality rates with the progression of Penn classification.