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Predictors of In-Hospital Mortality in Type A Acute Aortic Dissection
Session:
Posters (Sessão 1 - Écran 5) - Cirurgia Cardíaca
Speaker:
Isabel Maria Martins Moreira
Congress:
CPC 2023
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
26. Cardiovascular Surgery
Subtheme:
26.11 Cardiovascular Surgery - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Isabel Martins Moreira; Pedro Rocha Carvalho; Catarina Ribeiro Carvalho; Marta Catarina Bernardo; Pedro Mateus; Inês Silveira; Ilídio Moreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> <span style="background-color:white"><span style="color:black">Stanford Type A Acute Aortic Dissection (AAD) is the most common life-threatening disorder affecting the aorta </span></span>and is associated with a high rate of in-hospital mortality, even in patients that are surgically treated. Early recognition of patients that are at increased risk of death is important to guide clinicians for optimal treatment.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose:</strong> To determine predictors of in-hospital mortality in patients with type A AAD in our center.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> We performed a retrospective analysis of patients admitted with type A AAD in our center in the last 10 years. Association between patient characteristics and in-hospital mortality was evaluated.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Results: </span></strong><span style="color:black">A total of 75 patients with acute aortic syndrome were selected and 49 (65.3%) patients with </span>Stanford type A AAD were identified. Among these patients, 59.2% were male, with a mean age of 64±13 years. Hypertension was the most prevalent risk factor (62.5%), followed by dyslipidemia (31.3%), obesity (25%), smoking (14.6%) and previous cardiovascular disease (8.3%). At admission, most prevalent symptoms were chest pain (64.6%), abdominal pain (22.9%) and syncope (22.9%). 33.3% of patients presented with cardiogenic shock, 28.6% had ischemic ECG changes and 58.3% had pericardial effusion. Median aortic diameter was 51.0mm (IQR 47-58) and the dissection extended to the abdominal aorta in 49.6% of patients and to the supra-aortic trunks in 8.2%. 70.8% of patients underwent emergent cardiothoracic surgery, 4 patients died before surgery and 8 were not eligible due to multiple comorbidities. Total in-hospital mortality was 39.6%, with a median length of hospital stay of 9 days (IQR 2-19). Among patients that were treated surgically, 18.2% died before discharge.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In a multivariate regression analysis, independent predictors of in-hospital mortality were age (OR 1.122, 95%CI 1.003-1.255) and cardiogenic shock at admission (OR 25.914, 95%CI 1.324-507.391). Non-fatal cardiac arrest was also associated with higher mortality (p<0.001). There were no other significant differences in in-hospital mortality regarding risk factors, clinical presentation and aortic characteristics.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions:</strong> In our study, total in-hospital mortality in patients with type A AAD was 39.6%. Even in patients submitted to emergent cardiothoracic surgery, in-hospital mortality rate was 18.2%. In this group of patients, age and cardiogenic shock at admission were independent predictors of in-hospital mortality.</span></span></p>
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