ISSN 1671-5411 CN 11-5329/R

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2015 Vol. 12, No. 5

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Perioperative care in older adults
Giselle A Baquero, Michael W Rich
2015, 12(5): 465-469. doi: 10.11909/j.issn.1671-5411.2015.05.018
Abstract(1238)
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None
Secondary cardiovascular prevention in older adults: an evidence based review
Abdulla Damluji, Archana Ramireddy, Lynda Otalvaro, Daniel E Forman
2015, 12(5): 459-464. doi: 10.11909/j.issn.1671-5411.2015.05.019
Abstract(1492)
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None
PARADIGM-HF trial: will LCZ696 change the current treatment of systolic heart failure?
Edgardo Kaplinsky
2015, 12(5): 470-473. doi: 10.11909/j.issn.1671-5411.2015.05.010
Abstract(1404)
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None
Early prediction of myocardial viability after acute myocardial infarction by two-dimensional speckle tracking imaging
Jong Shin Woo, Tae-Kyung Yu, Woo-Shik Kim, Kwon Sam Kim, Weon Kim
2015, 12(5): 474-481. doi: 10.11909/j.issn.1671-5411.2015.05.002
Abstract(1477)
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Background Identifying the transmural extent of myocardial necrosis and the degree of myocardial viability in acute myocardial infarction (AMI) is important clinically. The aim of this study was to assess myocardial viability using two-dimensional speckle tracking imaging (2D-STI) in patients with AMI. Methods 2D-STI was performed at initial presentation, three days, and six months after primary percutaneous coronary intervention (PCI) in 30 patients with AMI, who had a left anterior descending coronary artery (LAD) culprit lesion. In addition, 20 patients who had minimal stenotic lesions (Results A total of 131 segments were viable, and 44 were nonviable. Multivariate analysis revealed significant differences between the viable and nonviable segments in the peak systolic strain, the peak systolic strain rate at initial presentation, and peak systolic strain rate three days after primary PCI. Among these, the initial peak systolic strain rate had the highest predictive value for myocardial viability (hazard ratio: 31.22, P Conclusions 2D-STI is feasible for assessing myocardial viability, and the peak systolic strain rate might be the most reliable predictor of myocardial viability in patients with AMI.
Is cardiac resynchronisation therapy (CRT) feasible, safe and beneficial in the very elderly?
Bartosz Olechowski, Rebecca Sands, Donah Zachariah, Neil P Andrews, Richard Balasubramaniam, Mark Sopher, John Paisey, Paul R Kalra
2015, 12(5): 497-501. doi: 10.11909/j.issn.1671-5411.2015.05.003
Abstract(1504)
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Objective To evaluate whether cardiac resynchronisation therapy (CRT) implantation was feasible and safe in octogenarians and the association with symptoms. Methods Consecutive patients undergoing CRT implantation were recruited from two UK centers. Patients grouped according to age: Results A total of 439 patients were included in this study, of whom 26% were aged ≥ 80 years. Octogenarians more often received cardiac resynchronization therapy pacemaker in comparison to cardiac resynchronisation therapy-defibrillator. Upgrade from pacemaker was common in both groups (16% P = NS). Co-morbidities were similarly common in both groups (overall diabetes: 25%, atrial fibrillation: 23%, hypertension: 45%). More patient age ≥ 80 years had significant chronic kidney disease (CKD, estimated glomerular filtration rate vs. 22%, P vs. 17%, P = NS). Both groups demonstrated symptomatic benefit. One-year mortality rates were almost four fold greater in octogenarians as compared with the younger cohort (13.9% vs. 3.7%, P Conclusions CRT appears to be safe in the very elderly despite extensive co-morbidity, and in particular frequent severe CKD. Symptomatic improvement appears to be meaningful. Strategies to increase the appropriate identification of elderly patients with CHF who are potential candidates for CRT are required.
Long-term stroke rates after catheter ablation or antiarrhythmic drug therapy for atrial fibrillation: a meta-analysis of randomized trials
Ya-Ru ZHENG, Zhi-Yun CHEN, Li-Fang YE, Li-Hong WANG
2015, 12(5): 507-514. doi: 10.11909/j.issn.1671-5411.2015.05.012
Abstract(1531)
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Background Atrial fibrillation (AF) is an independent risk factor for ischemic stroke and is associated with increased risk of death. Randomized studies suggest improved quality of life for patients with AF after successful catheter ablation compared to antiarrhythmic drug therapy. The value of ablation in long-term risk of ischemic stroke, however, has not been assessed. We conducted a meta-analysis to determine whether AF ablation reduces the long-term risk of stroke compared to antiarrhythmic drug therapy in randomized controlled trials. Methods & Results PubMed and the Cochrane Central Register were searched for randomized trials from January 1990 to December 2014 comparing AF catheter ablation to drug therapy. The results are reported as risk differences (RDs) and 95% CI. Thirteen trials were analyzed with 1097 patients treated by catheter ablation and 855 patients received antiarrhythmic drug therapy. Overall, seven patients (0.64%) in the catheter ablation group had ischemic stroke or transient ischemic attacks vs. two patients (0.23%) in the drug therapy group. No difference was shown in the rate of stroke or transient ischemic attack between ablation and drug therapy (RD: 0.003, 95%CI: -0.006 to 0.012, P = 0.470), and no evidence of heterogeneity was observed (I2 = 0%, P = 0.981). No potential publication bias was found. There was also no difference in mortality between the two groups (RD: ?0.004, 95% CI: ?0.014 to 0.006, P = 0.472). Conclusions This meta-analysis of randomized controlled trials showed similar rates of ischemic stroke or transient ischemic attack and death in AF patients undergoing catheter ablation compared to drug therapy. A larger prospective randomized trial to confirm this finding is warranted.
Serum uric acid as a prognostic marker in the setting of advanced vascular disease: a prospective study in the elderly
Giuseppe Di Stolfo, Sandra Mastroianno, Domenico Rosario Potenza, Giovanni De Luca, Carmela d'Arienzo, Michele Antonio Pacilli, Mario Fanelli, Aldo Russo, Raffaele Fanelli
2015, 12(5): 515-520. doi: 10.11909/j.issn.1671-5411.2015.05.008
Abstract(1689)
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Background Many epidemiological studies analyze the relationship between hyperuricemia and cardiovascular outcomes. This observational prospective study investigates the association of serum uric acid (SUA) levels with adverse cardiovascular events and deaths in an elderly population affected by advanced atherosclerosis. Methods Two hundred and seventy six elderly patients affected by advanced atherosclerosis (217 males and 59 females; aged 71.2 ± 7.8 years) were included. All patients were assessed for history of cardiovascular disease, cancer, obesity and traditional risk factors. Patients were followed for approximately 31 ± 11 months. Major events were recorded during follow-up, defined as myocardial infarction, cerebral ischemia, myocardial and/or peripheral revascularization and death. Results Mean SUA level was 5.47 ± 1.43 mg/dL; then we further divided the population in two groups, according to the median value (5.36 mg/dL). During a median follow up of 31 months (5 to 49 months), 66 cardiovascular events, 9 fatal cardiovascular events and 14 cancer-related deaths have occurred. The patients with increased SUA level presented a higher significant incidence of total cardiovascular events (HR: 1.867, P = 0.014, 95%CI: 1.134–3.074). The same patients showed a significant increased risk of cancer-related death (HR: 4.335, P = 0.025, 95%CI: 1.204–15.606). Conclusions Increased SUA levels are independently and significantly associated with risk of cardiovascular events and cancer related death in a population of mainly elderly patients affected by peripheral vasculopathy.
Dexamethasone, tetrahydrobiopterin and uncoupling of endothelial nitric oxide synthase
Silke Tobias, Alice Habermeier, Daniel Siuda, Gisela Reifenberg, Ning Xia, Ellen I Closs, Ulrich Förstermann, Huige Li
2015, 12(5): 528-539. doi: 10.11909/j.issn.1671-5411.2015.05.013
Abstract(1386)
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Objective To find out whether dexamethasone induces an uncoupling of the endothelial nitric oxide synthase (eNOS). Methods & Results A major cause of eNOS uncoupling is a deficiency of its cofactor tetrahydrobiopterin (BH4). Treatment of human EA.hy 926 endothelial cells with dexamethasone decreased mRNA and protein expression of both BH4-synthesizing enzymes: GTP cyclohydrolase I and dihydrofolate reductase. Consistently, a concentration- and time-dependent reduction of BH4, dihydrobiopterin (BH2) as well as BH4: BH2 ratio was observed in dexamethasone-treated cells. Surprisingly, no evidence for eNOS uncoupling was found. We then analyzed the expression and phosphorylation of the eNOS enzyme. Dexamethasone treatment led to a down-regulation of eNOS protein and a reduction of eNOS phosphorylation at serine 1177. A reduction of eNOS expression may lead to a relatively normal BH4: eNOS molar ratio in dexamethasone-treated cells. Because the B H4-eNOS stoichiometry rather than the absolute B H4 amount is the key determinant of eNOS functionality (i.e., coupled or uncoupled), the down-regulation of eNOS may represent an explanation for the absence of eNOS uncoupling. Phosphorylation of eNOS at serine 1177 is needed for both the NO-producing activity of the coupled eNOS and the superoxide-producing activity of the uncoupled eNOS. Thus, a reduction of serine 1177 phosphorylation may render a potentially uncoupled eNOS hardly detectable. Conclusions Although dexamethasone reduces BH4 levels in endothelial cells, eNOS uncoupling is not evident. The reduction of NO production in dexamethasone-treated endothelial cells is mainly attributable to reduced eNOS expression and decreased eNOS phosphorylation at serine 1177.
Panax quinquefolium saponin attenuates cardiomyocyte apoptosis induced by thapsigargin through inhibition of endoplasmic reticulum stress
Mi LIU, Mei XUE, Xiao-Reng WANG, Tian-Qi TAO, Fei-Fei XU, Xiu-Hua LIU, Da-Zhuo SHI
2015, 12(5): 540-546. doi: 10.11909/j.issn.1671-5411.2015.05.009
Abstract(1988)
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Background Endoplasmic reticulum (ER) stress-related apoptosis is involved in the pathophysiology of many cardiovascular diseases, and Panax quinquefolium (PQS) is able to inhibit excessive ER stress-related apoptosis of cardiomyocytes following hypoxia/reoxygenation and myocardial infarction. However, the pathway by which PQS inhibits the ER stress-related apoptosis is not well understood. To further investigate the protective effect of PQS against ER stress-related apoptosis, primary cultured cardiomyocytes were stimulated with thapsigargin (TG), which is widely used to model cellular ER stress, and it could induce apoptotic cell death in sufficient concentration. Methods Primary cultured cardiomyocytes from neonatal rats were exposed to TG (1 μmol/L) treatment for 24 h, following PQS pre-treatment (160 μg/mL) for 24 h or pre-treatment with small interfering RNA directed against protein kinase-like endoplasmic reticulum kinase (Si-PERK) for 6 h. The viability and apoptosis rate of cardiomyocytes were detected by cell counting kit-8 and flow cytometry respectively. ER stress-related protein expression, such as glucose-regulated protein 78 (GRP78), calreticulin, PERK, eukaryotic translation initiation factor 2α (eIF2α), activating transcription factor 4 (ATF4), and C/EBP homologous protein (CHOP) were assayed by western blotting. Results Both PQS pre-treatment and PERK knockdown remarkably inhibited the cardiomyocyte apoptosis induced by TG, increased cell viability, decreased phosphorylation of both PERK and eIF2α, and decreased protein levels of both ATF4 and CHOP. There was no statistically significant difference between PQS pre-treatment and PERK knockdown in the cardioprotective effect. Conclusions Our data indicate that the PERK-eIF2α-ATF4-CHOP pathway of ER stress is involved in the apoptosis induced by TG, and PQS might prevent TG-induced cardiomyocyte apoptosis through a mechanism involving the suppression of this pathway. These findings provide novel data regarding the molecular mechanisms by which PQS inhibits cardiomyocyte apoptosis.
A review on atrioventricular junction ablation and pacing for heart rate control of atrial fibrillation
Konstantinos Vlachos, Konstantinos P Letsas, Panagiotis Korantzopoulos, Tong Liu, Michael Efremidis, Antonios Sideris
2015, 12(5): 547-554. doi: 10.11909/j.issn.1671-5411.2015.05.005
Abstract(1690)
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Atrioventricular junction ablation with permanent pacemaker implantation is a highly effective treatment approach in patients with atrial fibrillation and high ventricular rates resistant to other treatment modalities, especially in the elderly or those with severe comorbidities. Compared with pharmacological therapy alone, the so-called “ablate and pace” approach offers the potential for more robust control of ven-tricular rate. Atrioventricular junction ablation and pacing strategy is associated with improvement in symptoms, quality of life, and exercise capacity. Given the close relationship between atrial fibrillation and heart failure, there is a particular benefit of such a rate control in patients with atrial fibrillation and reduced systolic function. There is increasing evidence that cardiac resynchronization therapy devices may be beneficial in selected populations after atrioventricular junction ablation. The present review article focuses on the current recommendations for atrioventricular junction ablation and pacing for heart rate control in patients with atrial fibrillation. The technique, the optimal implanta-tion time, and the proper device selection after atrioventricular junction ablation are also discussed.
Coronary revascularization in the elderly with stable angina
Kirill Lenarovich Kozlov, Aleksandr Andreevich Bogachev
2015, 12(5): 555-568. doi: 10.11909/j.issn.1671-5411.2015.05.017
Abstract(1202)
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A proportion of elderly with coronary artery disease is rapidly growing. They have more severe coronary artery disease, that’s why derive more benefit from revascularization and have a greater need for it. The elderly is heterogeneous group, but compared to the younger, the choice of the optimal revascularization method is much more complicated among them. In last decades, results has improved dramatically both in surgery and percutaneous coronary intervention (PCI), even in very old persons. Despite the lack of evidence in elderly, it is obvious, that coronary artery bypass surgery (CABG) has a more pronounced effect on long-term survival in price of more strokes, and PCI is less invasive. Age itself is not a criterion for the selection of treatment strategy, but the elderly are often more interested in quality of life and personal independence instead of longevity. This article discusses the factors that influence on the choice of revascularization method in the elderly with stable angina and presenting the complex algorithm for making an individual risk-benefit profile. Light upon features of CABG and PCI in elderly patients is thrown. Emphasis is made on the frailty and non-medical factors, including psychosocial, as an essential things in making decision of what strategy to choose. Good communication with the patients and giving them unbiased information is encouraged.
Impact of miRNAs on cardiovascular aging
Seahyoung Lee, Eunhyun Choi, Min-Ji Cha, Ae-Jun Park, Cheesoon Yoon, Ki-Chul Hwang
2015, 12(5): 569-574. doi: 10.11909/j.issn.1671-5411.2015.05.011
Abstract(1200)
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Aging is a multidimensional process that leads to an increased risk of developing severe diseases, such as cancer and cardiovascular, neurodegenerative, and immunological diseases. Recently, small non-coding RNAs known as microRNAs (miRNAs) have been shown to regulate gene expression, which contributes to many physiological and pathophysiological processes in humans. Increasing evidence suggests that changes in miRNA expression profiles contribute to cellular senescence, aging and aging-related diseases. However, only a few miRNAs whose functions have been elucidated have been associated with aging and/or aging-related diseases. This article reviews the currently available findings regarding the roles of aging-related miRNAs, with a focus on cardiac and cardiovascular aging.
Gender differences in the efficacy of cardiovascular rehabilitation in patients after cardiac surgery procedures
Mauro Feola, Sonia Garnero, Beatrice Daniele, Claudia Mento, Fabio Dell’Aira, Giuliana Chizzolini, Marzia Testa
2015, 12(5): 575-579. doi: 10.11909/j.issn.1671-5411.2015.05.015
Abstract(1115)
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None
Calcific degeneration and rupture of the aortic valve and ascending aorta: from cardiac auscultation to multimodality imaging
Davide Stolfo, Pasquale Gianfagna, Enrico Fabris, Davide Zanuttini, Gianfranco Sinagra, Alessandro Proclemer, Gaetano Nucifora
2015, 12(5): 580-583. doi: 10.11909/j.issn.1671-5411.2015.05.006
Abstract(1256)
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None
An uncommon cause of hypoxemia: platypnea-orthodeoxia syndrome
Sandra Schmid, Gregor John, Leonard Mossaz, Vassili Choutko
2015, 12(5): 584-587. doi: 10.11909/j.issn.1671-5411.2015.05.001
Abstract(1751)
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None
The oldest patient with takotsubo cardiomyopathy
Monika Budnik, Radoslaw Piatkowski, Janusz Kochanowski, Renata Glowczynskai, Dariusz Gorko, Robert Kowalik, Arkadiusz Pietrasik, Grzegorz Opolsk
2015, 12(5): 588-589. doi: 10.11909/j.issn.1671-5411.2015.05.014
Abstract(1104)
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None
Atrial fibrillation may be a hidden factor for the development of cognitive impairment in patients with heart failure
Omer Yiginer, Alptug Tokatli, Mehmet Dogan, Emrah Erdal
2015, 12(5): 590-590. doi: 10.11909/j.issn.1671-5411.2015.05.007
Abstract(1062)
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None
Effect of probucol on insulin resistance in patients with non-diabetic chronic kidney disease
Rui WANG, Ri-Bao WEI, Yue YANG, Na WANG, Meng-Jie HUANG, Cui-Ming CAO, Zi-Cheng WANG, Guang-Yan CAI, Xiang-Mei CHEN
2015, 12(5): 521-527. doi: 10.11909/j.issn.1671-5411.2015.05.020
Abstract(1623)
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Background Insulin resistance (IR) is present at all stages of chronic kidney disease (CKD) and is associated with CKD progression. Probucol can improve the prognosis of IR in diabetes mellitus (DM) patients. This study aimed to observe the effect of probucol on IR and kidney protection in non-diabetic CKD patients. Methods This was an open-label, non-placebo-controlled, randomized study. A total of 59 patients were randomized to the probucol group (0.5 g, twice daily) or the control group using a 1: 1 treatment ratio. IR was determined using a homeostatic model assessment-IR (HOMA-IR) index. An Excel database was established to analyze follow-up data at weeks 0, 12, and 24. The primary outcome of interest was changes in the HOMA-IR, and the secondary outcomes of interest were changes in the estimated glomerular filtration rate (eGFR), body mass index (BMI), cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, and 24-h urinary protein. Results The HOMA-IR index of the probucol group after 24 weeks was significantly decreased (P P = 0.041), cholesterol (P = 0.001), fasting insulin (P P = 0.001). Conclusions Compared to angiotensin receptor blockers alone, the combination with probucol ameliorates IR in non-diabetic CKD patients and delays disease progression.
Defective recovery of QT dispersion following transcatheter aortic valve implantation: frequency, predictors and prognosis
Rutger-Jan Nuis, Gokhan Turgut, Robert M van der Boon, Nicolas M Van Mieghem, Sjoerd T Nauta, Patrick W Serruys, Ron T van Domburg, Giulio Zuchelli, Luc Jordaens, Peter P de Jaegere
2015, 12(5): 482-488. doi: 10.11909/j.issn.1671-5411.2015.05.016
Abstract(1451)
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Background Corrected QT dispersion (cQTD) has been correlated with non-uniform ventricular repolarisation and increased mortality. In patients with aortic stenosis, cQTD has been shown improved after surgical valve replacement, but the effects of transcatheter aortic valve implantation (TAVI) are unknown. Therefore, we sought to explore the frequency, predictors and prognostic effects of defective cQTD recovery at 6 months after TAVI. Methods A total of 222 patients underwent TAVI with the Medtronic-CoreValve System between November 2005 and January 2012. Patients who were on classⅠor Ⅲ antiarrhythmics or on chronic haemodialysis or who developed atrial fibrillation, a new bundle branch block or became pacemaker dependent after TAVI were excluded. As a result, pre-, post- and follow-up ECG (median: 6 months) analysis was available in 45 eligible patients. Defective cQTD recovery was defined as any progression beyond the baseline cQTD at 6 months. Results In the 45 patients, the mean cQTD was 47 ± 23 ms at baseline, 45 ± 17 ms immediately after TAVI and 40 ± 16 ms at 6 months (15% reduction, P = 0.049). Compared to baseline, cQTD at 6 months was improved in 60% of the patients whereas defective cQTD recovery was present in 40%. cQTD increase immediately after TAVI was an independent predictor of defective cQTD recovery at 6 months (per 10 ms increase; OR: 1.89, 95% CI: 1.15–3.12). By univariable analysis, defective cQTD recovery was associated with late mortality (HR: 1.52, 95% CI: 1.05–2.17). Conclusions Despite a gradual reduction of cQTD after TAVI, 40% of the patients had defective recovery at 6 months which was associated with late mortality. More detailed ECG analysis after TAVI may help to avoid late death.
Transradial versus transfemoral rotablation for heavily calcified coronary lesions in contemporary drug-eluting stent era
Wei-Hsian Yin, Chin-Kun Tseng, Tien-Ping Tsao, Hsu-Lung Jen, Wen-Pin Huang, Chien-Lung Huang, Jiann-Jong Wang, Mason Shing Young
2015, 12(5): 489-496. doi: 10.11909/j.issn.1671-5411.2015.05.004
Abstract(1477)
Abstract:
Background Corrected QT dispersion (cQTD) has been correlated with non-uniform ventricular repolarisation and increased mortality. In patients with aortic stenosis, cQTD has been shown improved after surgical valve replacement, but the effects of transcatheter aortic valve implantation (TAVI) are unknown. Therefore, we sought to explore the frequency, predictors and prognostic effects of defective cQTD recovery at 6 months after TAVI. Methods A total of 222 patients underwent TAVI with the Medtronic-CoreValve System between November 2005 and January 2012. Patients who were on classⅠor Ⅲ antiarrhythmics or on chronic haemodialysis or who developed atrial fibrillation, a new bundle branch block or became pacemaker dependent after TAVI were excluded. As a result, pre-, post- and follow-up ECG (median: 6 months) analysis was available in 45 eligible patients. Defective cQTD recovery was defined as any progression beyond the baseline cQTD at 6 months. Results In the 45 patients, the mean cQTD was 47 ± 23 ms at baseline, 45 ± 17 ms immediately after TAVI and 40 ± 16 ms at 6 months (15% reduction, P = 0.049). Compared to baseline, cQTD at 6 months was improved in 60% of the patients whereas defective cQTD recovery was present in 40%. cQTD increase immediately after TAVI was an independent predictor of defective cQTD recovery at 6 months (per 10 ms increase; OR: 1.89, 95% CI: 1.15–3.12). By univariable analysis, defective cQTD recovery was associated with late mortality (HR: 1.52, 95% CI: 1.05–2.17). Conclusions Despite a gradual reduction of cQTD after TAVI, 40% of the patients had defective recovery at 6 months which was associated with late mortality. More detailed ECG analysis after TAVI may help to avoid late death.
Incidence and in-hospital mortality of acute aortic dissection in China: Analysis of China Health Insurance Research (CHIRA) Data 2011
Lei XIA, Jing-Hu LI, Kun ZHAO, Hai-Yun WU
2015, 12(5): 502-506. doi: 10.11909/j.issn.1671-5411.2015.05.021
Abstract(1713)
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Objective Acute aortic dissection (AAD) is a catastrophic event with high early mortality rate, but to date, no data on the incidence of AAD in Mainland China is available. This study aimed to estimate the incidence of AAD in China and characterize the clinical profile, management and in-hospital outcomes of this vascular event. Methods We used the China Health Insurance Research Data (the CHIRA Data) 2011 which comprises all inpatient hospital records (300,886) during the period of Jan. 1st 2011 to Dec. 31 2011 of 3,335,000 randomly sampled beneficiaries (1,718,500 men and 1,616,500 women) from 25 cities and counties in different economic-geographic regions of Mainland China. Patients with acute aortic dissection were identified according to International Classification of Disease 10th Revision (ICD-10) of I71.0. The estimated incidence of AAD was calculated using the equation: estimated incidence = 2.0 × (40% × hospital admission rate) + 60% × hospital admission rate. Results The hospital admission rate was 2.0/100,000 (65/3,325,000, 95% CI: 1.2–2.8). The estimated annual incidence of AAD was 2.8/100,000 (95% CI: 1.9–3.6) and was higher in male than in female (3.7 vs. 1.5, P Conclusions Our study showed relatively lower but not negligible incidence and in-hospital mortality of AAD in the mainland of China. The mean age of patients with AAD in Chinese was younger than that reported by researches from west countries, while the male to female incidence ratio is similar to those reported by other studies.