{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T15:47:58Z","timestamp":1781279278906,"version":"3.54.1"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T00:00:00Z","timestamp":1741737600000},"content-version":"vor","delay-in-days":11,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Tegger Foundation"},{"name":"Medical Education and Research Sweden"},{"name":"Swedish Heart Lung Foundation"},{"name":"Torsten Westerstr\u00f6ms stiftelse"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>The high mortality in untreated acute type A aortic dissection (ATAAD) stresses the need for prompt diagnosis and immediate surgical treatment. Our aim was to evaluate the frequency and clinical impact of misdiagnosis and delayed diagnosis of ATAAD.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>This was a single-centre, retrospective, observational study including all ATAAD patients with available admission charts between 2001 and 2021 in an area of 1.9 million inhabitants in southern Sweden. The primary endpoints were initial misdiagnosis, delayed diagnosis, and 30-day mortality. Surgical treatment was a secondary endpoint. Independent predictors of misdiagnosis and 30-day mortality were identified by multivariable logistic regression and subgroup analyses by severity of clinical presentation were performed. There were 556 patients included in the study (418 surgically treated and 138 non-surgically treated), and 45.3% were initially misdiagnosed. Misdiagnosed patients were more often female (47.6 vs. 35.9%; P = 0.005) and demonstrated significantly lower rates of syncope, hypotensive shock, and malperfusion. Patients without signs of malperfusion subjected to diagnostic delay were less likely offered surgical treatment (74.0 vs. 91.5%; P &amp;lt; 0.001) and had higher 30-day mortality (21.3 vs. 10.8%; P = 0.040). Female sex was an independent predictor of misdiagnosis (OR: 1.748; 95% CI 1.145\u20132.668; P = 0.010), but neither misdiagnosis nor delayed diagnosis were independent predictors of 30-day mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Although misdiagnosis and delayed diagnosis did not influence overall 30-day mortality, delayed diagnosis led to significantly higher 30-day mortality in the large group of patients presenting without signs of malperfusion, likely caused by the observed higher risk of being denied surgical treatment.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjopen\/oeaf027","type":"journal-article","created":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T08:37:46Z","timestamp":1741768666000},"source":"Crossref","is-referenced-by-count":6,"title":["Causes and clinical impact of initial misdiagnosis of acute type A aortic dissection"],"prefix":"10.1093","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7605-0608","authenticated-orcid":false,"given":"Karl","family":"Teurneau-Hermansson","sequence":"first","affiliation":[{"name":"Department of Clinical Sciences Lund, Department of Cardiothoracic Surgery, Lund University, Sk\u00e5ne University Hospital , Lund SE-221 85 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"von Rosen","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund, Department of Cardiothoracic Surgery, Lund University, Sk\u00e5ne University Hospital , Lund SE-221 85 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4165-3940","authenticated-orcid":false,"given":"Jacob","family":"Ede","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund, Department of Cardiothoracic Surgery, Lund University, Sk\u00e5ne University Hospital , Lund SE-221 85 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2303-2369","authenticated-orcid":false,"given":"M\u00e5rten","family":"Larsson","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund, Department of Cardiothoracic Surgery, Lund University, Sk\u00e5ne University Hospital , Lund SE-221 85 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7965-7491","authenticated-orcid":false,"given":"Johan","family":"Sj\u00f6gren","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund, Department of Cardiothoracic Surgery, Lund University, Sk\u00e5ne University Hospital , Lund SE-221 85 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per","family":"Wierup","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund, Department of Cardiothoracic Surgery, Lund University, Sk\u00e5ne University Hospital , Lund SE-221 85 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5786-864X","authenticated-orcid":false,"given":"Shahab","family":"Nozohoor","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund, Department of Cardiothoracic Surgery, Lund University, Sk\u00e5ne University Hospital , Lund SE-221 85 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6017-2555","authenticated-orcid":false,"given":"Igor","family":"Zindovic","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund, Department of Cardiothoracic Surgery, Lund University, Sk\u00e5ne University Hospital , Lund SE-221 85 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,3,12]]},"reference":[{"key":"2025032600460886000_oeaf027-B1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/14017431.2019.1660401","article-title":"Acute type A aortic dissection\u2014a review","volume":"54","author":"Gudbjartsson","year":"2020","journal-title":"Scand Cardiovasc J"},{"key":"2025032600460886000_oeaf027-B2","doi-asserted-by":"crossref","first-page":"2031","DOI":"10.1161\/CIRCULATIONAHA.112.000483","article-title":"Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford Vascular Study","volume":"127","author":"Howard","year":"2013","journal-title":"Circulation"},{"key":"2025032600460886000_oeaf027-B3","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1016\/j.ijcard.2017.05.024","article-title":"Insight into the incidence of acute aortic dissection in the German region of Berlin and Brandenburg","volume":"241","author":"Kurz","year":"2017","journal-title":"Int J Cardiol"},{"key":"2025032600460886000_oeaf027-B4","doi-asserted-by":"crossref","first-page":"e001513","DOI":"10.1161\/JAHA.114.001513","article-title":"Risk profiles for aortic dissection and ruptured or surgically treated aneurysms: a prospective cohort study","volume":"4","author":"Landenhed","year":"2015","journal-title":"J Am Heart Assoc"},{"key":"2025032600460886000_oeaf027-B5","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1093\/ejcts\/ezw235","article-title":"The incidence and mortality of acute thoracic aortic dissection: results from a whole nation study","volume":"50","author":"Melvinsdottir","year":"2016","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025032600460886000_oeaf027-B6","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1016\/S0140-6736(14)61005-9","article-title":"Management of acute aortic 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from the international registry of acute aortic dissection: a 20-year experience of collaborative clinical research","volume":"137","author":"Evangelista","year":"2018","journal-title":"Circulation"},{"key":"2025032600460886000_oeaf027-B10","doi-asserted-by":"crossref","first-page":"2628","DOI":"10.1016\/j.jacc.2015.04.030","article-title":"The impact of pre-operative malperfusion on outcome in acute type A aortic dissection: results from the GERAADA registry","volume":"65","author":"Czerny","year":"2015","journal-title":"J Am Coll Cardiol"},{"key":"2025032600460886000_oeaf027-B11","doi-asserted-by":"crossref","first-page":"730.e19","DOI":"10.1016\/j.amjmed.2013.01.020","article-title":"The IRAD classification system for characterizing survival after aortic dissection","volume":"126","author":"Booher","year":"2013","journal-title":"Am J Med"},{"key":"2025032600460886000_oeaf027-B12","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1001\/jama.283.7.897","article-title":"The 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