Abstract
Objectives:
In recent years, several epidemiologic studies have shown that pulse pressure (PP) is a powerful predictor of mortality from many cardiovascular diseases. However, few studies have reported the association between PP and adverse events during hospitalization in patients with type A acute aortic dissection (TAAAD). The aim of this study was to evaluate the relationship between admission PP and in-hospital all-cause mortality, in patients with TAAAD.
Methods:
Patients with TAAAD admitted from January 2015 to December 2021 were included and divided into four groups according to the PP values measured at the time of admission: reduced group (PP ≤ 40 mmHg), normal group (40 < PP ≤ 56 mmHg), mildly elevated group (56 < PP ≤ 75 mmHg), and significantly elevated group (PP > 75 mmHg). A multivariate binary logistic regression model was constructed, plotted using nomogram and evaluated with ROC curve.
Results:
Admission PP and in-hospital all-cause mortality showed a "J-curve" correlation and in-hospital all-cause mortality was significantly higher in the significantly elevated group and reduced group (P = 0.003), respectively. Multivariate binary logistic regression analysis showed that significantly elevated PP (PP > 75 mmHg) (P<0.001) and reduced PP (P = 0.043), D-dimer (P<0.001), ascending aortic diameter (P = 0.037), Abdominal visceral vessels involved (P = 0.019), and coronary atherosclerosis (P = 0.017) and emergent surgery (P < 0.001) were independent predictive factors for in-hospital all-cause mortality. The AUC of ROC plotted was 0.825 (95% CI, 0.780–0.870).
Conclusions:
Our findings demonstrated a "J-curve" association of admission PP with in-hospital all-cause mortality in TAAAD. Significantly elevated and reduced admission PP, D-dimer, ascending aortic diameter and coronary atherosclerosis were independent risk factors for in-hospital all-cause mortality in patients with TAAAD, and emergent surgery was a protective factor.