Predictors of In-Hospital Mortality in Type A Acute Aortic Syndrome: Data From the RENADA-RO Registry - 02/07/24

Doi : 10.1016/j.hlc.2024.02.016

Diana-Cristina Matei, MD ^a,^b,^⁎ , Elena-Laura Antohi, MD, PhD ^a,^b, Răzvan Ilie Radu, MD, PhD ^a,^b, Celia Georgiana Ciobanu, MD ^a,^b, Oliviana Dana Geavlete, MD, PhD ^a,^b, Daniela Filipescu, MD, PhD ^a,^b, Șerban Bubenek, MD, PhD ^a,^b, Horațiu Moldovan, MD, PhD ^b,^c,^d, Vlad Anton Iliescu, MD, PhD ^a,^b, Ovidiu Dragomir Chioncel, MD, PhD ^a,^b
^a Emergency Institute for Cardiovascular Diseases “Prof. Dr. C.C. Iliescu” Bucharest, Romania
^b University of Medicine and Pharmacy "Carol Davila" Bucharest, Romania
^c Emergency Clinical Hospital, Bucharest, Romania
^d The Academy of Romanian Scientists (AOSR), Bucharest, Romania

^∗Corresponding author at: Street Fundeni 258, Bucharest, RomaniaStreet Fundeni 258BucharestRomania

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Abstract

Background

This study aimed to analyse the baseline characteristics of patients admitted with acute type A aortic syndrome (ATAAS) and to identify the potential predictors of in-hospital mortality in surgically managed patients.

Methods

Data regarding demographics, clinical presentation, laboratory work-up, and management of 501 patients with ATAAS enrolled in the National Registry of Aortic Dissections—Romania registry from January 2011 to December 2022 were evaluated. The primary endpoint was in-hospital all-cause mortality. Multivariate logistic regression was conducted to identify independent predictors of mortality in patients with acute Type A aortic dissection (ATAAD) who underwent surgery.

Results

The mean age was 60±11 years and 65% were male. Computed tomography was the first-line diagnostic tool (79%), followed by transoesophageal echocardiography (21%). Cardiac surgery was performed in 88% of the patients. The overall mortality in the entire cohort was 37.9%, while surgically managed ATAAD patients had an in-hospital mortality rate of 29%. In multivariate logistic regression, creatinine value (OR 6.76), ST depression on ECG (OR 6.3), preoperative malperfusion (OR 5.77), cardiogenic shock (OR 5.77), abdominal pain (OR 4.27), age ≥70 years (OR 3.76), and syncope (OR 3.43) were independently associated with in-hospital mortality in surgically managed ATAAD patients.

Conclusions

Risk stratification based on the variables collected at admission may help to identify ATAAS patients with high risk of death following cardiac surgery.

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Keywords : Aorta, Acute type A aortic syndrome, Acute type A aortic dissection, In-hospital mortality predictors for acute type A aortic dissection, Epidemiology