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Acute Aortic Syndromes in a center without on-site cardiac surgery
Session:
Sessão de Posters 15 - Patologias diversas em Cardiologia
Speaker:
Joana Massa Pereira
Congress:
CPC 2024
Topic:
P. Other
Theme:
37. Miscellanea
Subtheme:
22.4 Aortic Disease - Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Joana Massa Pereira; Sofia Andraz; Lucas Hamann; Hugo Alex Costa; Miguel Espírito Santo; Daniela Carvalho; Pedro Azevedo; Raquel Fernandes; Dina Bento; João Sousa Bispo; Jorge Mimoso
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong>Acute aortic syndromes (AAS) are often the first form of presentation of aorta artery diseases, especially classic acute aortic dissection (AAD), with a high mortality rate. Distance to a surgical center and consequently treatment time delay may influence the prognosis of this syndrome. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Objective: </strong>Characterize the population that suffered an AAS at a hospital without on-site cardiac surgery and without an established emergent pathway in AAS. Analyze global mortality and gender differences in in-hospital mortality (primary outcome) and cardiovascular mortality at 1 year. Try to identify independent predictors of in-hospital mortality in AAS patients.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> Retrospective study between 2017/2020, composed of n=57 patients who suffered AAS. Categorical variables are presented as frequencies and percentages, and continuous variables as means and standard deviations, or medians and interquartile ranges for variables with skewed distribution or a significant Shapiro-Wilk test. Multivariate analysis was performed using logistic regression. P value < 0.05 indicates statistical significance.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> A total of 57 patients were identified, with a mean age of 65.9 ± 16.2 years, 80.7% were male. 80.4% had hypertension, 48.2% dyslipidemia, 23.2% obesity, 32.1% were smokers and 55.4% had history of aortic dilation. Spontaneous aortic dissection (54.4%) affecting thoracic and abdominal aorta (36.8%) was the more common presentation. The majority of patients were transferred to a reference center (71.9%) with a mean time delay of 15.5±17.3h. Time until transfer ≥ 6h occurred in 78.9% of patients. In-hospital mortality occurred in 41.2%, and 45.6% died after 1 year, without differences between gender. Independent predictors of mortality were time until transfer ≥ 6h (p=0.048, OR 11.1, 95% CI 1.03 to 120), without transfer to a reference center (p=0.005, OR 86.7, 95% CI 3.82 to 1969) and smoking status (p=0.043, OR 5.02, 95% CI 1.05 to 24.1).</span></span></p> <p><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Conclusion: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">We report a pool of patients with a syndrome that affects especially males, with high mortality (almost half in our sample) but without differences between gender. Mortality predictors were patients without transfer to a reference center or with a transfer time delay </span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">≥ 6h</span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">. By the exposed, an emergent pathway structured protocol in AAS and the existence of an on-site cardiac surgery team could be a reality. </span></span></p>
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