BACKGROUND: Syncope is a well-recognized symptom of acute aortic dissection, often indicating the development of dangerous complications such as cardiac tamponade. SUBJECTS AND METHODS: We identified consecutive patients with acute aortic dissection at 18 referral centers in six countries. Data on key clinical findings and outcomes were collected via extensive questionnaires. Multiple logistic regression models were used to determine the association between syncope and in-hospital mortality, adjusting for demographic characteristics, dissection type, comorbid conditions, and complications (e.g., cardiac tamponade). RESULTS: Syncope was reported in 96 (13%) of 728 patients. Patients with syncope were more likely to die in the hospital (34% [n = 33 deaths]) than were those without syncope (23% [144/632], P = 0.01). They were also more likely to have cardiac tamponade (28% [n = 27] vs. 8% [n = 49], P <0.001), stroke (18% [n = 17] vs. 4% [n = 27], P <0.001), and other neurologic deficits (25% [n = 24] vs. 14% [n = 88], P = 0.005). After multivariate adjustment, clinical factors independently associated with the occurrence of syncope included a proximal dissection (odds ratio [OR] = 5.5; 95% confidence interval [CI]: 2.5 to 12; P <0.001), cardiac tamponade (OR = 3.1; 95% CI: 1.7 to 5.4; P <0.001), and stroke (OR = 3.5; 95% CI: 1.7 to 7.2; P = 0.001). There was a significant association between in-hospital death and syncope after adjustment for demographic characteristics alone (OR = 2.0; 95% CI: 1.2 to 3.5; P = 0.01), but not after adjustment for dissection type, comorbid conditions, and complications. CONCLUSION: Patients with dissections complicated by cardiac tamponade or stroke are significantly more likely to present with syncope. If these complications are excluded, syncope alone does not appear to increase the risk of death independently.
BACKGROUND:Syncope is a well-recognized symptom of acute aortic dissection, often indicating the development of dangerous complications such as cardiac tamponade. SUBJECTS AND METHODS: We identified consecutive patients with acute aortic dissection at 18 referral centers in six countries. Data on key clinical findings and outcomes were collected via extensive questionnaires. Multiple logistic regression models were used to determine the association between syncope and in-hospital mortality, adjusting for demographic characteristics, dissection type, comorbid conditions, and complications (e.g., cardiac tamponade). RESULTS:Syncope was reported in 96 (13%) of 728 patients. Patients with syncope were more likely to die in the hospital (34% [n = 33 deaths]) than were those without syncope (23% [144/632], P = 0.01). They were also more likely to have cardiac tamponade (28% [n = 27] vs. 8% [n = 49], P <0.001), stroke (18% [n = 17] vs. 4% [n = 27], P <0.001), and other neurologic deficits (25% [n = 24] vs. 14% [n = 88], P = 0.005). After multivariate adjustment, clinical factors independently associated with the occurrence of syncope included a proximal dissection (odds ratio [OR] = 5.5; 95% confidence interval [CI]: 2.5 to 12; P <0.001), cardiac tamponade (OR = 3.1; 95% CI: 1.7 to 5.4; P <0.001), and stroke (OR = 3.5; 95% CI: 1.7 to 7.2; P = 0.001). There was a significant association between in-hospital death and syncope after adjustment for demographic characteristics alone (OR = 2.0; 95% CI: 1.2 to 3.5; P = 0.01), but not after adjustment for dissection type, comorbid conditions, and complications. CONCLUSION:Patients with dissections complicated by cardiac tamponade or stroke are significantly more likely to present with syncope. If these complications are excluded, syncope alone does not appear to increase the risk of death independently.
Authors: Ernst Weigang; Christoph A Nienaber; Tim C Rehders; Hüseyin Ince; Christian-Friedrich Vahl; Friedhelm Beyersdorf Journal: Dtsch Arztebl Int Date: 2008-09-19 Impact factor: 5.594
Authors: Gilson Soares Feitosa-Filho; José Maria Peixoto; José Elias Soares Pinheiro; Abrahão Afiune Neto; Afonso Luiz Tavares de Albuquerque; Álvaro César Cattani; Amit Nussbacher; Ana Amelia Camarano; Angela Hermínia Sichinels; Antonio Carlos Sobral Sousa; Aristóteles Comte de Alencar Filho; Claudia F Gravina; Dario Celestino Sobral Filho; Eduardo Pitthan; Elisa Franco de Assis Costa; Elizabeth da Rosa Duarte; Elizabete Viana de Freitas; Emilio Hideyuki Moriguchi; Evandro Tinoco Mesquita; Fábio Fernandes; Gilson Soares Feitosa; Humberto Pierre; Ilnei Pereira Filho; Izo Helber; Jairo Lins Borges; Jéssica Myrian de Amorim Garcia; José Antonio Gordillo de Souza; José Carlos da Costa Zanon; Josmar de Castro Alves; Kalil Lays Mohallem; Laura Mariana de Siqueira Mendonça Chaves; Lídia Ana Zytynski Moura; Márcia Cristina Amélia da Silva; Maria Alice de Vilhena Toledo; Maria Elisa Lucena Sales de Melo Assunção; Mauricio Wajngarten; Mauro José Oliveira Gonçalves; Neuza Helena Moreira Lopes; Nezilour Lobato Rodrigues; Paulo Roberto Pereira Toscano; Pedro Rousseff; Ricardo Antonio Rosado Maia; Roberto Alexandre Franken; Roberto Dischinger Miranda; Roberto Gamarski; Ronaldo Fernandes Rosa; Silvio Carlos de Moraes Santos; Siulmara Cristina Galera; Stela Maris da Silva Grespan; Teresa Cristina Rogerio da Silva; William Antonio de Magalhães Esteves Journal: Arq Bras Cardiol Date: 2019-06-06 Impact factor: 2.000
Authors: Todd C Crawford; Robert J Beaulieu; Bryan A Ehlert; Elizabeth V Ratchford; James H Black Journal: Vasc Med Date: 2016-02-08 Impact factor: 3.239