Treatment strategies and in-hospital mortality in patients with type A acute aortic dissection and coronary artery involvement

被引:17
作者
Hashimoto, Osamu [1 ]
Saito, Yuichi [2 ]
Sasaki, Haruka [2 ,3 ]
Yumoto, Keita [4 ]
Oshima, Susumu [5 ]
Tobaru, Tetsuya [3 ]
Kanda, Junji [6 ]
Sakai, Yoshiaki [1 ]
Yasuda, Satoshi [7 ,8 ]
机构
[1] Chiba Emergency Med Ctr, Dept Cardiol, Chiba, Japan
[2] Chiba Univ, Grad Sch Med, Dept Cardiovasc Med, 1-8-1 Inohana,Chuo Ku, Chiba, Chiba 2608677, Japan
[3] Kawasaki Saiwai Hosp, Dept Cardiol, Kawasaki, Kanagawa, Japan
[4] Kawasaki Saiwai Hosp, Dept Cardiovasc Surg, Kawasaki, Kanagawa, Japan
[5] Kawasaki Saiwai Hosp, Dept Aort Surg, Kawasaki, Kanagawa, Japan
[6] Asahi Gen Hosp, Dept Cardiovasc Med, Asahikawa, Hokkaido, Japan
[7] Natl Cerebral & Cardiovasc Ctr, Dept Cardiovasc Med, Suita, Osaka, Japan
[8] Tohoku Univ, Grad Sch Med, Dept Cardiovasc Med, Sendai, Miyagi, Japan
关键词
type A aortic dissection; coronary artery involvement; surgery; percutaneous coronary intervention; outcomes; ACUTE MYOCARDIAL-INFARCTION; INTERNATIONAL REGISTRY; PROGNOSTIC IMPACT; MALPERFUSION; INSIGHTS;
D O I
10.1016/j.jtcvs.2022.03.016
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: Type A acute aortic dissection (AAD), especially that with coronary artery involvement and malperfusion, is a life -threatening disease. In the present study we aimed to investigate the association of surgical treatment and percutaneous coronary intervention (PCI) with in -hospital mortality in patients with type A AAD and coronary artery involvement. Methods: This retrospective multicenter registry in Japan included 225 patients with type A AAD and coronary artery involvement. Treatment strategies including surgical treatment and/or PCI were left to treating physicians. The primary end point was in -hospital death. Results: Of 225 patients, dissection extended into the right and left coronary arteries and both in 115 (51.1%), 105 (46.7%), and 5 (2.2%), respectively. Overall, 94 (41.8%) patients died during the hospitalization. Coronary angiography was performed in 53 (23.6%) patients, among whom 39 (73.6%) underwent PCI. Surgical repair was performed in 188 (83.6%) patients. In patients who received neither procedure, 33 of 35 (94.3%) died during the hospitalization. PCI was performed as a bridge to surgical repair in 37 of 39 (94.9%) patients, and in -hospital mortality of patients who underwent PCI and surgical procedures was 24.3%. Multivariable analysis identified PCI and surgical procedures as factors associated with lower inhospital mortality rates. Conclusions: Coronary artery involvement in type A AAD was associated with high in -hospital mortality of more than 40% in the current era. An early reperfusion strategy with PCI as a bridge to surgical repair might improve clinical outcomes in this fatal condition. (J Thorac Cardiovasc Surg 2024;167:596-601)
引用
收藏
页码:596 / 601.e3
页数:9
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