Risk factors for 24-hour death in acute type A aortic dissection patients with conservative treatment_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XUE Yuan ^1,2 ,  ZHANG Hongjia ¹

1. Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P.R.China;
2. Department of Cardiac Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, P.R.China;

Corresponding author：

ZHANG Hongjia, Email: zhanghongjia722@ccmu.edu.cn

Keywords：

Acute type A aortic dissection; aortic regurgitation; left ventricular end diastolic diameter; risk factors

DOI：

10.7507/1007-4848.202006049

Video：

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Objective To explore the risk factors for 24-hour death in acute type A aortic dissection (ATAAD) patients with conservative treatment.Methods From January 2009 to January 2018, 243 ATAAD patients who received non-surgical intervention were admitted in Beijing Anzhen Hospital, including 167 males and 76 females with an average age of 53.0±12.0 years. The risk factors for 24-hour mortality were analyzed.Results The total in-hospital mortality rate was 37.9% (93/243), and 13.6% (33/243) patients died within 24 hours of onset. We found that left ventricular end diastolic diameter [LVEDD, OR=0.45, 95%CI (0.25, 0.83), P<0.01] and aortic regurgitation [OR=7.26, 95%CI (1.67, 31.53), P<0.01] were independent risk factors for 24-hour death in patients with ATAAD.Conclusion In this study, LVEDD and aortic regurgitation are identified as independent risk factors for 24-hour mortality in ATAAD patients. Therefore, patients with aortic regurgitation and small LVEDD should be treated with sugery as soon as possible.

Citation： XUE Yuan, ZHANG Hongjia. Risk factors for 24-hour death in acute type A aortic dissection patients with conservative treatment. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(8): 935-939. doi: 10.7507/1007-4848.202006049 Copy

1.	Evangelista A, Isselbacher EM, Bossone E, et al. Insights from the international registry of acute aortic dissection: A 20-year experience of collaborative clinical research. Circulation, 2018, 137: 1846-1860.
2.	Meszaros I, Morocz J, Szlavi J, et al. Epidemiology and clinicopathology of aortic dissection: A population-based longitudinal study over 27 years. Chest, 2000, 117: 1271-1278.
3.	Hirst A. Dissecting aneurysm of the aorta: A review of 505 cases. Medicine, 1958, 37(3): 217.
4.	Greenland P, Alpert JS, Beller GA, et al. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 2010, 122(25): 2748-2764.
5.	Mody PS, Wang Y, Geirsson A, et al. Trends in aortic dissection hospitalizations, interventions, and outcomes among medicare beneficiaries in the United States, 2000-2011. Circ Cardiovasc Qual Outcomes, 2014, 7(6): 920-928.
6.	Booher AM, Isselbacher EM, Nienaber CA, et al. The IRAD classification system for characterizing survival after aortic dissection. Am J Med, 2013, 126(8): 730.e19-24.
7.	Lohse F, Lang N, Schiller W, et al. Quality of life after replacement of the ascending aorta in patients with true aneurysms. Tex Heart Inst J, 2009, 36(2): 104-110.
8.	Immer FF, Lippeck C, Barmettler H, et al. Improvement of quality of life after surgery on the thoracic aorta: Effect of antegrade cerebral perfusion and short duration of deep hypothermic circulatory arrest. Circulation, 2004, 110(11 Suppl 1): Ⅱ250-Ⅱ255.
9.	Li ZD, Liu Y, Zhu J, et al. Risk factors of pre-operational aortic rupture in acute and subacute Stanford type A aortic dissection patients. J Thorac Dis, 2017, 9(12): 4979-4987.
10.	Apaydin AZ, Buket S, Posacioglu H, et al. Perioperative risk factors for mortality in patients with acute type A aortic dissection. Ann Thorac Surg, 2002, 74(6): 2034-2039.
11.	Daily PO, Trueblood HW, Stinson EB, et al. Management of acute aortic dissections. Ann Thorac Surg, 1970, 10(3): 237-247.
12.	Masuda Y, Takanashi K, Takasu J, et al. Natural history and prognosis of medical treatment for the patients with aortic dissections. Nippon Geka Gakkai zasshi, 1996, 97(10): 890-893.
13.	Masuda Y. Prognosis of patients with medically treated aortic dissections. Circulation, 1991, 84(5 Suppl): Ⅲ7-Ⅲ13.
14.	戎天华, 潘旭东, 刘宁宁, 等. Stanford A 型主动脉夹层合并急性下肢缺血的临床研究现状与展望. 心肺血管病杂志, 2015, 34(11): 867-870.
15.	Bruno C, Marc S, Erwin T, et al. Early and late outcomes of acute type A aortic dissection: analysis of risk factors in 487 consecutive patients. Eur Heart J, 2005, 26(2): 180-186.
16.	Mehta RH, Suzuki T, Hagan PG, et al. Predicting death in patients with acute type A aortic dissection. Circulation, 2002, 105(2): 200-206.
17.	Iarussi D, Caruso A, Galderisi M, et al. Association of left ventricular hypertrophy and aortic dilation in patients with acute thoracic aortic dissection. Angiology, 2001, 52(7): 447-455.
18.	Kawahito K, Adachi H, Yamaguchi A, et al. Preoperative risk factors for hospital mortality in acute type A aortic dissection. Ann Thorac Surg, 2001, 71(4): 1239-1243.
19.	Wen D, Du X, Dong JZ, et al. Value of D-dimer and C reactive protein in predicting inhospital death in acute aortic dissection. Heart, 2013, 99(16): 1192-1197.
20.	Tian L, Fan X, Zhu J, et al. Plasma D-dimer and in-hospital mortality in patients with Stanford type A acute aortic dissection. Blood Coagul Fibrinolysis, 2014, 25(2): 161-166.
21.	Suzuki T, Distante A, Zizza A, et al. Diagnosis of acute aortic dissection by D-dimer: The International Registry of Acute Aortic Dissection Substudy on Biomarkers (IRAD-Bio) experience. Circulation, 2009, 119(20): 2702-2707.
22.	Paparella D, Malvindi PG, Scrascia G, et al. D-dimers are not always elevated in patients with acute aortic dissection. J Cardiovasc Med, 2009, 10(2): 212-214.
23.	李海洋, 韩露, 王晓龙, 等. D-二聚体与对急性 A 型主动脉夹层手术预后的关系. 心肺血管病杂志, 2017, 36(5): 386-389.

1. Evangelista A, Isselbacher EM, Bossone E, et al. Insights from the international registry of acute aortic dissection: A 20-year experience of collaborative clinical research. Circulation, 2018, 137: 1846-1860.
2. Meszaros I, Morocz J, Szlavi J, et al. Epidemiology and clinicopathology of aortic dissection: A population-based longitudinal study over 27 years. Chest, 2000, 117: 1271-1278.
3. Hirst A. Dissecting aneurysm of the aorta: A review of 505 cases. Medicine, 1958, 37(3): 217.
4. Greenland P, Alpert JS, Beller GA, et al. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 2010, 122(25): 2748-2764.
5. Mody PS, Wang Y, Geirsson A, et al. Trends in aortic dissection hospitalizations, interventions, and outcomes among medicare beneficiaries in the United States, 2000-2011. Circ Cardiovasc Qual Outcomes, 2014, 7(6): 920-928.
6. Booher AM, Isselbacher EM, Nienaber CA, et al. The IRAD classification system for characterizing survival after aortic dissection. Am J Med, 2013, 126(8): 730.e19-24.
7. Lohse F, Lang N, Schiller W, et al. Quality of life after replacement of the ascending aorta in patients with true aneurysms. Tex Heart Inst J, 2009, 36(2): 104-110.
8. Immer FF, Lippeck C, Barmettler H, et al. Improvement of quality of life after surgery on the thoracic aorta: Effect of antegrade cerebral perfusion and short duration of deep hypothermic circulatory arrest. Circulation, 2004, 110(11 Suppl 1): Ⅱ250-Ⅱ255.
9. Li ZD, Liu Y, Zhu J, et al. Risk factors of pre-operational aortic rupture in acute and subacute Stanford type A aortic dissection patients. J Thorac Dis, 2017, 9(12): 4979-4987.
10. Apaydin AZ, Buket S, Posacioglu H, et al. Perioperative risk factors for mortality in patients with acute type A aortic dissection. Ann Thorac Surg, 2002, 74(6): 2034-2039.
11. Daily PO, Trueblood HW, Stinson EB, et al. Management of acute aortic dissections. Ann Thorac Surg, 1970, 10(3): 237-247.
12. Masuda Y, Takanashi K, Takasu J, et al. Natural history and prognosis of medical treatment for the patients with aortic dissections. Nippon Geka Gakkai zasshi, 1996, 97(10): 890-893.
13. Masuda Y. Prognosis of patients with medically treated aortic dissections. Circulation, 1991, 84(5 Suppl): Ⅲ7-Ⅲ13.
14. 戎天华, 潘旭东, 刘宁宁, 等. Stanford A 型主动脉夹层合并急性下肢缺血的临床研究现状与展望. 心肺血管病杂志, 2015, 34(11): 867-870.
15. Bruno C, Marc S, Erwin T, et al. Early and late outcomes of acute type A aortic dissection: analysis of risk factors in 487 consecutive patients. Eur Heart J, 2005, 26(2): 180-186.
16. Mehta RH, Suzuki T, Hagan PG, et al. Predicting death in patients with acute type A aortic dissection. Circulation, 2002, 105(2): 200-206.
17. Iarussi D, Caruso A, Galderisi M, et al. Association of left ventricular hypertrophy and aortic dilation in patients with acute thoracic aortic dissection. Angiology, 2001, 52(7): 447-455.
18. Kawahito K, Adachi H, Yamaguchi A, et al. Preoperative risk factors for hospital mortality in acute type A aortic dissection. Ann Thorac Surg, 2001, 71(4): 1239-1243.
19. Wen D, Du X, Dong JZ, et al. Value of D-dimer and C reactive protein in predicting inhospital death in acute aortic dissection. Heart, 2013, 99(16): 1192-1197.
20. Tian L, Fan X, Zhu J, et al. Plasma D-dimer and in-hospital mortality in patients with Stanford type A acute aortic dissection. Blood Coagul Fibrinolysis, 2014, 25(2): 161-166.
21. Suzuki T, Distante A, Zizza A, et al. Diagnosis of acute aortic dissection by D-dimer: The International Registry of Acute Aortic Dissection Substudy on Biomarkers (IRAD-Bio) experience. Circulation, 2009, 119(20): 2702-2707.
22. Paparella D, Malvindi PG, Scrascia G, et al. D-dimers are not always elevated in patients with acute aortic dissection. J Cardiovasc Med, 2009, 10(2): 212-214.
23. 李海洋, 韩露, 王晓龙, 等. D-二聚体与对急性 A 型主动脉夹层手术预后的关系. 心肺血管病杂志, 2017, 36(5): 386-389.

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