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Published on: March 26, 2018

Applicability of Guideline-Based Aortic Intervention Thresholds in the Indian Population

Nimrat Grewal1,2, Mohammed Idhrees3, Jedidiah Samraj3

  • 1Amsterdam University Medical Center, University of Amsterdam, Department of Cardiothoracic Surgery, Netherlands, Amsterdam.

The Thoracic and Cardiovascular Surgeon
|July 30, 2026
PubMed

Insights

Clinical guidelines for aortic dissection use Western-based diameter thresholds. In South Asians, these thresholds are rarely met, yet dissections still occur disproportionately in larger aortas, suggesting a need for population-specific interpretations.

Area of Science:

  • Cardiovascular Medicine
  • Vascular Surgery
  • Radiology

Background:

  • Current clinical guidelines for thoracic aortopathy utilize absolute diameter thresholds for surveillance and intervention.
  • These thresholds are primarily derived from Western populations and applied globally, irrespective of regional variations in vascular dimensions.

Purpose of the Study:

  • To compare ascending aortic diameter distributions in a South Asian general population versus patients with acute Stanford type A aortic dissection (ATAAD).
  • To evaluate the applicability of current guideline-based diameter thresholds in a South Asian cohort.

Main Methods:

  • A counterfactual, denominator-based analysis was conducted.
  • Ascending aortic diameter and body surface area (BSA)-indexed diameter were compared between a South Asian general population (n=2,000) and ATAAD patients (n=71).
  • Bayesian 95% credible intervals were used for exposure ratio analysis.

Main Results:

  • The South Asian general population exhibited a narrow aortic diameter distribution (median 30.2 mm; 95th percentile 37.6 mm), with <1% exceeding the 45 mm guideline threshold.
  • Acute Stanford type A aortic dissection (ATAAD) cases presented across a wide diameter range (median 52 mm; indexed median 28.0 mm/m²), concentrated in the upper tail of both absolute and BSA-indexed distributions.
  • BSA indexing amplified the disproportionate concentration of dissections in the higher diameter ranges.

Conclusions:

  • Absolute diameter thresholds in current guidelines represent a very small proportion of the South Asian population.
  • Despite this, aortic dissections in this population are concentrated at the higher end of the diameter spectrum, even after BSA indexing.
  • Findings support the need for population-aware interpretation of aortic size thresholds in clinical practice.
Abstract

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