Retrospective Analysis Of The Related Factors Of The Occurrence And Death Of Aortic Dissection

Objective:To study the clinical manifestations and positive diagnosis rate of AD patients as well as factors related to the occurrence and death of AD, we retrospectively analyzed the clinical data in our hospital within two years of the patients suspected of AD and examined by the CTA, which was the standard of this practise. Meanwhile, the difference of features between type A an B patients of the Stanford classification was compared, and a follow-up of patients was performed, to find out the prognosis of patients treated differently, and give clinicians some references.Methods:458 patients(273 cases in male, 185 cases in female) suspected of AD and examined by CTA from August, 2013 to October, 2015 in Jilin University First Hospital were included. Firstly, patients were divided into the AD group(97 men, 45 women, mean age 52.15±0.97 a) and the control group(176 men, 140 women, mean age 61.74±1.30 a).The general information, clinical manifestation, laboratory examination of both groups were compared. Secondly, the AD group were further divided into the type A(33 men, 17 women,mean age 51.76 ± 1.09 a) and type B(63 men, 29 women, mean age 53.10 ± 1.15 a)according to the Stanford classification. The general information, clinical manifestation,laboratory examination of both types were also compared. Thirdly, the death ones(3 men,7women, mean age 56.30 ± 9.67 a) were partitioned from the survival ones(91 men, 41 women, mean age 52.17 ± 11.62 a) within the AD group and the difference between the clinical data of both were compared. Lastly, we reckoned the time of symptom onset of the AD patients and the time required for diagnosis, followed up the AD group after discharge(69 cases, follow-up rate is 63.30%), assessed the prognosis of different treatments by statistically analyzing the risk factors of the occurrence and death of AD.Results:1. The positive diagnosis rate of aortic dissection in our hospital is 31%(142/458). The time of symptom onset of aortic dissection is 0.5 hours to 3 months(78.71 ±2.37 hours), and the required time of diagnosis is 0~72 hours(5.88 ± 1.12 hours).2. In the univariate analysis, men(68.31%)is more than women(31.69%) in the aortic dissection group, and the average age of aortic dissection group is lower than that of the controlgroup(P<0.05). 3.In the univariate analysis, the percentages of chest pain and precordial pain are higher in the aortic dissection group than in the control group(P<0.05). 4. In the univariate analysis, the percentages of smoking, drinking, hypertension or elevated blood pressure at admission are higher in the aortic dissection group than in the control group(P<0.05). 5.In the univariate analysis, the percentages of the patients with the increased Ddimer, the increased BNP, aortic valve regurgitation or pericardial effusion are higher in the aortic dissection group than in the control group(P<0.05). 6.In the univariate analysis,the percentages of the patients with diabetes and chest pressure are lower in the aortic dissection group than in the control group(P<0.05).7.In the univariate analysis, the proportion of type B aortic dissection group who had chest pain and elevated blood pressure is higher than that of type A aortic dissection group(P < 0.05).8.In the univariate analysis, the in- hospital mortality of women was higher than men’s(P<0.05). The percentages of smoking, drinking,hypertension or elevated blood pressure at admission are higher in the aortic dissection group than in the control group(P<0.05), the percentages of the patients with the increased D-dimer, the increased BNP, the increased cTNI, pericardial effusion or aortic valve regurgitation are lower in the aortic dissection group than in the control group(P<0.05). 9.In the Logistic regression analysis, chest pain, hypertension or elevated blood pressure,drinking, the increased D-dimer and the increased BNP were correlated with aortic dissection, and hypertension(OR:8.396,95%CI:3.94~17.885) and drinking(OR:38.772,95%CI:4.31~348.822) are the risk factors of AD(P < 0.05). Diabetes mellitus(OR:0.157,95%CI:0.039~0.622) was negatively correlated with the incidence of aortic dissection(P<0.05).10. In 25 surgical patients, 24 cases type A aortic dissection(2 deaths),1 cases type B aortic dissection(no death), in-hospital mortality is 8%. In 69 interventional treatment patients with type B aortic dissection(1 death), in-hospital mortality is 2.90%. In25 conservative treatment patients, 4 cases type A aortic dissection(3 deaths), 21 cases type B aortic dissection(3 deaths), in-hospital mortality is 24%. 11.69 people were followed after discharged(follow-up rate was 63.30%, 48 men, 21 women). The follow-up time was10.87±9.33 months, 14 cases of the surgical treatment group in the follow-up(follow-up rate was 56%), 1 death(no dissection rupture), 45 cases of the interventional treatment group in the follow-up(follow-up rate was 65.22%), 1 death(no dissection rupture), 3 deaths(no dissection rupture), 10 cases of the conservative treatment group in the follow-up(follow-uprate was 40%), 4 deaths(dissection rupture),1 death(no dissection rupture).Conclusions:1.The incidence of aortic dissection is higher in males than in females, and the in-hospital mortality rate higher in females than in males. 2. The onset symptom is mostly pain symptom, and chest pain as the main clinical manifestation. 3. The patients with type B aortic dissection are more likely to have chest pain and elevated blood pressure when admitted to hospital. 4. Drinking and hypertension are the risk factors of AD. 5. The in-hospital mortality rate(24%) of conservative treatment is higher than which of surgical treatment(8%) and interventional treatment(2.90%), and the proportion of deaths of conservative treatment in the follow-up(4/10) is higher than which of surgical(0/14) and interventional treatment(0/45).