Abstract 10684: Aortic Dissection During Pregnancy and Puerperium: Contemporary Incidence and Outcomes in the United States

Abstract

Background: Aortic dissection (AD) during pregnancy and puerperium is a rare yet potentially fatal catastrophe for both parent and fetus, yet population-level trends in incidence and outcomes are undetermined. Objectives: To investigate the incidence and in-hospital outcomes of AD during pregnancy and puerperium in a US national database. Methods: The National Inpatient Sample, a large and publicly available all-payer inpatient care database, was queried to identify pregnancy-related AD hospitalizations using codes from the International Classification of Diseases (ICD-9 and ICD-10). Identified hospitalizations were stratified into Stanford type A AD (TAAD) and type B AD (TBAD) using the associated procedure codes. The weighted values of the hospitalizations were used to generate national estimates. Results: From January 2002 to December 2017, a total of 471 pregnancy-related AD hospitalizations were identified, with 106 (22.5%) being TAAD and 365 (77.5%) being TBAD. The mean age of the entire cohort was 30.9 ± 0.6 years; 52.1% were White, 20.6% were Hispanic, and 9.4% were Black. Marfan syndrome, primary hypertension, and pre-eclampsia/eclampsia were found in 21.9%, 11.3%, and 13.2%. Although trimester information was only available in hospitalizations with ICD-10 codes (18.0% of the entire cohort), we found that 58.8% of AD occurred in the third trimester. Overall, the incidences of AD, TAAD, and TBAD were 0.66, 0.15, and 0.51 per 100,000 pregnancy-related hospitalizations. We observed a trend of increasing incidence for pregnancy-related AD (Fig 1) during the 16-year study period - predominantly driven by TBAD. The in-hospital mortalities of AD, TAAD, and TBAD were 7.3%, 4.3%, and 8.1%. Conclusions: For the first time, we quantified the population-level incidence and in-hospital outcomes of AD during pregnancy and puerperium in the US; while its incidence is increasing, its in-hospital mortality appears better than that of the general population.