Eduardo Bossone1, David C Corteville, Kevin M Harris, Toru Suzuki, Rossella Fattori, Stuart Hutchison, Marek P Ehrlich, Reed E Pyeritz, Philippe Gabriel Steg, Kevin Greason, Arturo Evangelista, Eva Kline-Rogers, Daniel G Montgomery, Eric M Isselbacher, Christoph A Nienaber, Kim A Eagle. 1. Department of Cardiology, University of Salerno, Salerno, Italy (E.B.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI (D.C.C., E.K.-R., D.G.M., K.A.E.); Abbott-Northwestern Hospital, Minneapolis Heart Institute, Minneapolis, MN (K.M.H.); Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan (T.S.); Department of Interventional Cardiology, San Salvatore Hospital, Pesaro, Italy (R.F.); Department of Cardiac Sciences, University of Calgary, Calgary, Canada (S.H.); Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria (M.P.E.); Division of Medical Genetics, University of Pennsylvania, Philadelphia, PA (R.E.P.); Department of Cardiology, Hôpital Bichat, Paris, France (P.G.S.); Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN (K.G.); Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain (A.E.); Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA (E.M.I.); and Department of Internal Medicine, University of Rostock, Rostock, Germany (C.A.N.).
Abstract
BACKGROUND: Stroke is a highly dreaded complication of type A acute aortic dissection (TAAAD). However, little data exist on its incidence and association with prognosis. METHODS AND RESULTS: We evaluated 2202 patients with TAAAD (mean age 62 ± 14 years, 1487 [67.5%] men) from the International Registry of Acute Aortic Dissection to determine the incidence and prognostic impact of stroke in TAAAD. Stroke was present at arrival in 132 (6.0%) patients with TAAAD. These patients were older (65 ± 12 versus 62 ± 15 years; P=0.002) and more likely to have hypertension (86% versus 71%; P=0.001) or atherosclerosis (29% versus 22%; P=0.04) than patients without stroke. Chest pain at arrival was less common in patients with stroke (70% versus 82%; P<0.001), and patients with stroke presented more often with syncope (44% versus 15%; P<0.001), shock (14% versus 7%; P=0.005), or pulse deficit (51% versus 29%; P ≤ 0.001). Arch vessel involvement was more frequent among patients with stroke (68% versus 37%; P<0.001). They had less surgical management (74% versus 85%; P<0.001). Hospital stay was significantly longer in patients with stroke (median 17.9 versus 13.3 days; P<0.001). In-hospital complications, such as hypotension, coma, and malperfusion syndromes, and in-hospital mortality (adjusted odds ratio, 1.62; 95% confidence interval, 0.99-2.65) were higher among patients with stroke. Among hospital survivors, follow-up mortality was similar between groups (adjusted hazard ratio, 1.15; 95% confidence interval, 0.46-2.89). CONCLUSIONS: Stroke occurred in >1 of 20 patients with TAAAD and was associated with increased in-hospital morbidity but not long-term mortality. Whether aggressive early invasive interventions will reduce negative outcomes remains to be evaluated in future studies.
BACKGROUND:Stroke is a highly dreaded complication of type A acute aortic dissection (TAAAD). However, little data exist on its incidence and association with prognosis. METHODS AND RESULTS: We evaluated 2202 patients with TAAAD (mean age 62 ± 14 years, 1487 [67.5%] men) from the International Registry of Acute Aortic Dissection to determine the incidence and prognostic impact of stroke in TAAAD. Stroke was present at arrival in 132 (6.0%) patients with TAAAD. These patients were older (65 ± 12 versus 62 ± 15 years; P=0.002) and more likely to have hypertension (86% versus 71%; P=0.001) or atherosclerosis (29% versus 22%; P=0.04) than patients without stroke. Chest pain at arrival was less common in patients with stroke (70% versus 82%; P<0.001), and patients with stroke presented more often with syncope (44% versus 15%; P<0.001), shock (14% versus 7%; P=0.005), or pulse deficit (51% versus 29%; P ≤ 0.001). Arch vessel involvement was more frequent among patients with stroke (68% versus 37%; P<0.001). They had less surgical management (74% versus 85%; P<0.001). Hospital stay was significantly longer in patients with stroke (median 17.9 versus 13.3 days; P<0.001). In-hospital complications, such as hypotension, coma, and malperfusion syndromes, and in-hospital mortality (adjusted odds ratio, 1.62; 95% confidence interval, 0.99-2.65) were higher among patients with stroke. Among hospital survivors, follow-up mortality was similar between groups (adjusted hazard ratio, 1.15; 95% confidence interval, 0.46-2.89). CONCLUSIONS:Stroke occurred in >1 of 20 patients with TAAAD and was associated with increased in-hospital morbidity but not long-term mortality. Whether aggressive early invasive interventions will reduce negative outcomes remains to be evaluated in future studies.
Authors: Bo Yang; Elizabeth L Norton; Carlo Maria Rosati; Xiaoting Wu; Karen M Kim; Minhaj S Khaja; G Michael Deeb; David M Williams; Himanshu J Patel Journal: J Thorac Cardiovasc Surg Date: 2018-12-14 Impact factor: 5.209
Authors: Elizabeth L Norton; Xiaoting Wu; Linda Farhat; Karen M Kim; Himanshu J Patel; G Michael Deeb; Bo Yang Journal: Ann Thorac Surg Date: 2019-08-09 Impact factor: 4.330
Authors: Julia Merkle; Anton Sabashnikov; Antje-Christin Deppe; Mohamed Zeriouh; Johanna Maier; Carolyn Weber; Kaveh Eghbalzadeh; Georg Schlachtenberger; Olga Shostak; Ilija Djordjevic; Elmar Kuhn; Parwis B Rahmanian; Navid Madershahian; Christian Rustenbach; Oliver Liakopoulos; Yeong-Hoon Choi; Ferdinand Kuhn-Régnier; Thorsten Wahlers Journal: Ther Adv Cardiovasc Dis Date: 2018-10-08