Examining the face of aortic dissection outside the Western world

Abstract

Aortic dissection is a challenging foe, having earned a well-deserved reputation as the great masquerader by virtue of the fact that its presentation canmimic awide range of diseases. Dissection can present as myocardial infarction, stroke, paraplegia, leg ischemia, renal failure, and abdominal catastrophe—reflecting the fact that dissection can disrupt blood flow to any organ in the body (see Figure 1). As challenging as aortic dissection can be to recognize and treat, we have largely experienced the behavior of this disease only in the West. Variations around theworldmay contribute to even greater complexity thanwe have appreciated. Genetic, environmental, and social factors may produce differences in behavior of aortic dissection in other environments. The study by Wang and colleagues gives us a look at the face of acute aortic dissection in China. Specifically, Wang and colleagues describe their new Registry of Aortic Dissection in China (Sino-RAD), which currently includes>1000 patients presenting acutely to 15 different centers across the country during a 2-year period. The authors provide a descriptive report of the patients included in Sino-RAD as well as a statistical comparison of clinical characteristics with the International Registry of Acute Aortic Dissection (IRAD). Establishing this nationwide database is a major accomplishment, and the authors are to be congratulated on this achievement as well as on their well-written report. This new information from China supplements the important work previously reported by Sun and colleagues describing their singlecenter experience treating >450 acute type A aortic dissection patients in Beijing. Compared with IRAD (which represents aortic dissection patterns predominantly in Western countries), Sino-RAD, representative solely of Chinese patients with aortic dissection, reveals several distinctive features of this disease in China: