Eduardo Bossone1, Riccardo Gorla2, Troy M LaBounty3, Toru Suzuki4, Dan Gilon5, Craig Strauss6, Andrea Ballotta7, Himanshu J Patel8, Arturo Evangelista9, Marek P Ehrlich10, Stuart Hutchison11, Eva Kline-Rogers3, Daniel G Montgomery3, Christoph A Nienaber12, Eric M Isselbacher13, Kim A Eagle3. 1. Heart Department, University of Salerno, Salerno, Italy. Electronic address: ebossone@hotmail.com. 2. Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato, Italy. 3. Cardiovascular Center, University of Michigan, Ann Arbor, Michigan. 4. Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom. 5. Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel. 6. Cardiovascular Division, Minneapolis Heart Institute, Minneapolis, Minnesota, United States. 7. Department of Cardiothoracic and Vascular Anesthesia, IRCCS Policlinico San Donato, San Donato, Italy. 8. Cardiac Surgery, University of Michigan, Ann Arbor, Michigan. 9. Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain. 10. Cardiothoracic Surgery, University of Vienna, Vienna, Austria. 11. Department of Cardiac Sciences, University of Calgary Medical Centre, Calgary, Canada. 12. Cardiology and Aortic Centre, The Royal Bromptom & Harefield NHS Trust, London, United Kingdom. 13. Thoracic Aortic Center, Massachusetts General Hospital, Boston, Massachusetts.
Abstract
BACKGROUND: Presenting systolic blood pressure (SBP) is a powerful predictor of mortality in many cardiovascular settings, including acute coronary syndromes, cardiogenic shock, and acute heart failure. OBJECTIVES: This study evaluated the association of presenting SBP with in-hospital outcomes, specifically all-cause mortality, in acute aortic dissection (AAD). METHODS: The study included 6,238 consecutive patients (4,167 with type A and 2,071 with type B AAD) enrolled in the International Registry of Acute Aortic Dissection. Patients were stratified in 4 groups according to presenting SBP: SBP >150, SBP 101 to 150, SBP 81 to 100, or SBP ≤80 mm Hg. RESULTS: The relationship between presenting SBP and in-hospital mortality displayed a J-curve association, with significantly higher mortality rates in patients with very high SBP (26.3% for SBP >180 mm Hg in type A AAD, 13.3% for SBP >200 mm Hg in type B AAD; p = 0.005 and p = 0.018, respectively) as well as in those with SBP ≤100 mm Hg (29.9% in type A, 22.4% in type B; p = 0.033 and p = 0.015, respectively). This relationship was mainly from increased rates of in-hospital complications (acute renal failure, coma, and mesenteric ischemia/infarction in patients with SBP >150 mm Hg; stroke, coma, cardiac tamponade, myocardial ischemia/infarction, and acute renal failure in patients with SBP ≤80 mm Hg). Notably, presenting SBP ≤80 mm Hg was independently associated with in-hospital mortality in both type A (p = 0.001) and type B AAD (p = 0.003). CONCLUSIONS: Presenting SBP showed a clear J-curve relationship with in-hospital mortality in patients with AAD. Although this association was related to increased rates of comorbid conditions at the edges of the curve, SBP ≤80 mm Hg was an independent correlate of in-hospital mortality.
BACKGROUND: Presenting systolic blood pressure (SBP) is a powerful predictor of mortality in many cardiovascular settings, including acute coronary syndromes, cardiogenic shock, and acute heart failure. OBJECTIVES: This study evaluated the association of presenting SBP with in-hospital outcomes, specifically all-cause mortality, in acute aortic dissection (AAD). METHODS: The study included 6,238 consecutive patients (4,167 with type A and 2,071 with type B AAD) enrolled in the International Registry of Acute Aortic Dissection. Patients were stratified in 4 groups according to presenting SBP: SBP >150, SBP 101 to 150, SBP 81 to 100, or SBP ≤80 mm Hg. RESULTS: The relationship between presenting SBP and in-hospital mortality displayed a J-curve association, with significantly higher mortality rates in patients with very high SBP (26.3% for SBP >180 mm Hg in type A AAD, 13.3% for SBP >200 mm Hg in type B AAD; p = 0.005 and p = 0.018, respectively) as well as in those with SBP ≤100 mm Hg (29.9% in type A, 22.4% in type B; p = 0.033 and p = 0.015, respectively). This relationship was mainly from increased rates of in-hospital complications (acute renal failure, coma, and mesenteric ischemia/infarction in patients with SBP >150 mm Hg; stroke, coma, cardiac tamponade, myocardial ischemia/infarction, and acute renal failure in patients with SBP ≤80 mm Hg). Notably, presenting SBP ≤80 mm Hg was independently associated with in-hospital mortality in both type A (p = 0.001) and type B AAD (p = 0.003). CONCLUSIONS: Presenting SBP showed a clear J-curve relationship with in-hospital mortality in patients with AAD. Although this association was related to increased rates of comorbid conditions at the edges of the curve, SBP ≤80 mm Hg was an independent correlate of in-hospital mortality.