Ann Thorac Surg 2019 Dec 28. Epub 2019 Dec 28.
Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China; and Aortic Institute at Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA.
Background: To examine if chronologic and climatic factors and lunar phases affect the onset of acute aortic dissection (AAD).
Methods: The frequencies of AADs were analyzed with regard to the chronologic and climatic factors and lunar phases on the day when AAD occurred for 1642 patients with AAD from two aortic referral centers in U.S. and China.
Results: Mean age was 51.6±13.1 years and 1260 (76.7%) were men. Dissection was type A in 1125 (68.5%) and type B in 517 (31.5%) patients. Early mortality rate was 11.6% (190/1642), including 89 aortic ruptures prior to operation and 101 operative deaths. There was a winter peak in occurrence (33.6%, P<0.01) with a relative risk of 1.519. In a week, the frequency was highest on Wednesday (15.5%) and Monday (15.2%), and lowest on Sunday (12.8%). Month-specific incidence was significantly inversely correlated to the mean temperature (rho = -0.650, P=0.022) and directly correlated to the atmospheric pressure (rho=0.706, P=0.001). The proportion of type A dissection was significantly higher in the full moon phase compared to type B dissection (73.7% vs 66.9%, P=0.012).
Conclusions: AAD exhibits significant chronologic variation in the frequency of occurrence, with a peak in winter and on Wednesdays, and nadir in summer and on Sundays. The incidence is significantly correlated to the mean temperature and atmospheric pressure. The proportion of type A dissection is higher in full moon phase. These results are important for understanding the mechanisms involved in triggering AAD events and helpful for improving disease prevention and patient care.