Short-term outcomes of acute coronary involvement in type A aortic dissection without myocardial ischemia: a multiple center retrospective cohort study

Author:

Wang Maozhou,Fan Ruixin,Gu Tianxiang,Zou Chengwei,Zhang Zonggang,Liu Zhonghong,Qiao Chenhui,Sun Lizhong,Gong Ming,Li Haiyang,Zhang HongjiaORCID

Abstract

Abstract Background To evaluate the early prognosis and management of acute coronary involvement (ACI) in type A aortic dissection (ATAAD) patients without myocardial ischemia (MI). Methods We conducted a retrospective cohort study on a multicenter database. A total of 931 ATAAD patients without MI underwent thoracic aortic surgery between 2018 and 2019 in the Acute Aortic Syndrome Cooperation Network (AASCN) and were enrolled in our study. Patients were divided into two groups: ACI group and non-ACI group. Results There were 139 ACI patients (14.9%) and 792 non-ACI patients (85.1%) in our cohort. ACI group had higher 30-day mortality after surgery than non-ACI group (log-rank test: P = 0.028,Cox regression: hazard ratio [HR], 2.3; 95% confidence interval [95% CI], 1.1–5.39; P = 0.047), especially in sub-group of advanced age (53–80 years; HR, 4.0; 95% CI, 1.3–12.8; P = 0.017), low diastolic blood pressure (29-69 mmHg, HR, 3.8; 95% CI, 1.3–11.2; P = 0.018), low systolic blood pressure (51–119 mmHg, HR, 3.6; 95% CI, 1.1–12.4; P = 0.040), high body mass index (BMI;27.25–47.52 kg/m2; HR, 3.7; 95% CI, 1.3–10.7; P = 0.015) and high hemoglobin (>145 g/L; HR, 4.3; 95% CI, 1.2–16.0; P = 0.030). Acute renal failure was significant more in ACI group than non-ACI group (24.5% vs. 15.9%; P = 0.014). Conclusions ACI increases the short-term postoperative mortality and acute renal failure in ATAAD patients without MI. ATAAD patients with ACI may need a narrower control range of blood pressure even if without myocardial ischemia. Trial registration ChiCTR1900022637. Retrospectively registered 19 April 2019.

Funder

National Key R&D Program of China

National Natural Science Foundation of China

Publisher

Springer Science and Business Media LLC

Subject

Cardiology and Cardiovascular Medicine,General Medicine,Surgery,Pulmonary and Respiratory Medicine

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