Clinical Characteristics Of Acute Stanford Type A Aortic Dissection And Analysis Of Risk Factors For Early Death

Background and ObjectiveAortic Dissection(AD)is a life-threatening cardiovascular emergency with sudden onset,rapid progression,and complexity.It is characterized by aortic intimal tear or intramural hemorrhage.Especially acute Stanford type A aortic dissection(ATAAD),which is a medical emergency,has a high mortality rate without surgical treatment.However,most studies assessing predictors of death in AD patients focus on surgical cohorts,or fail to distinguish acute from chronic,type A from type B aortic dissection.Therefore,the predictors of death in patients with ATAAD are still unclear.Considering the high mortality rate of ATAAD,we comprehensively analyze the related clinical variables and their relationship with 30-day mortality.The aim is to identify and predict the independent risk factors of death in patients with ATAAD early,enhance the understanding of the disease and improve the level of clinical prevention and treatment.MethodsA retrospective analysis was made of 317 cases of TAAAD hospitalized in our hospital from January 2013 to December 2018.According to the 30-day survival,the patients were divided into survival group and death group.The measurement data were analyzed by independent sample t test or variance analysis.The counting data were analyzed by Pearsonχ2 test or Fisher exact probability method.The critical value of the measurement data was analyzed by ROC curve and then converted into binary metadata.The variables with statistical significance were analyzed by multivariate binary logistic regression.ResultsA total of 317 patients with ATAAD were enrolled,including 249 males(78.54%)and 68 females(21.46%)with a male-to-female ratio of 3.66:1.The average age of onset was 50.23±12.31 years old,the predisposing age was 41-60years old,and the predisposing age of females was 10 years later than that of males.The onset of ATAAD was obviously seasonal,with a significant increase in winter incidence.Among them,281 cases(88.64%)had pain manifestations;169 cases(53.31%)had hypertension.119(37.54%)had smoking history and 276(87.07%)had pericardial effusion after onset.Age>67 years old,syncope,aortic valve insufficiency,mitral valveinsufficiency,pericardial effusion,pleural effusion,white blood cell count>9.75×10~9/L,neutrophil absolute value>7.32×10~9/L,cardiac troponin I>0.72μg/L were influential factors of death for patients with ATAAD,but none was anindependent risk factor.Multivariate logistic regression analysis showed that shock(OR:2.183,P=0.032),Neutrophil to Lymphocyte Ratio(NLR)>8.38(OR:5.328,P=0.019),D-dimer>12.91 mg/L(OR:3.199,P=0.025)were independent risk factors for death in patients with ATAAD.However,surgery or interventional therapy(OR:0.732,P=0.000)was a protective factor for patients with ATAAD.Conclusions1.ATAAD was more predominant in winter,men were more likely to beaffected than women,women were more likely to delay the age than men,pain was often the first symptom,hypertension was the most common basic disease,clinical attention should be paid to the control of blood pressure.2.The independent risk factors for death in ATAAD patients were shock,NLR>8.38 and D-dimer>12.91 mg/L.Surgery or interventional therapy was a protective factor for ATAAD patients.