Predictors of in-hospital mortality in type A acute aortic dissection: a 10-year retrospective analysis

Stanford Type A Acute Aortic Dissection (AAD) is the most common life-threatening disorder affecting the aorta and is associated with a high rate of in-hospital mortality, even in patients that are surgically treated. Early recognition of patients that are at increased risk of mortality is important to guide clinicians for optimal treatment.

We performed a retrospective analysis of patients admitted with type A AAD in our centre in the last 10 years to determine the predictors of in-hospital mortality in this population. Association between patient characteristics and in-hospital mortality was evaluated.

A total of 75 patients with acute aortic syndrome were selected and 49 (65.3%) patients with Stanford type A AAD were identified. Among these patients, 59.2% were male, with a mean age of 64±13 years. Hypertension was the most prevalent risk factor (62.5%), followed by dyslipidemia (31.3%), obesity (25%), smoking (14.6%) and previous cardiovascular disease (8.3%). At admission, the most prevalent symptoms were chest pain (64.6%), abdominal pain (22.9%) and syncope (22.9%). 33.3% of patients presented with shock, 28.6% had ischemic ECG changes and 58.3% had pericardial effusion. Median aortic diameter was 51.0mm (IQR 47-58) and the dissection extended to the abdominal aorta in 49.6% of patients and to the supra-aortic trunks in 8.2%. 70.8% of patients underwent emergent cardiothoracic surgery, 4 patients died before surgery and 8 were not eligible due to multiple comorbidities. Total in-hospital mortality was 39.6%, with a median length of hospital stay of 9 days (IQR 2-19). Among patients that were treated surgically, 18.2% died before discharge. In a multivariate regression analysis, independent predictors of in-hospital mortality were age (OR 1.122, 95%CI 1.003-1.255) and shock at admission (OR 25.914, 95%CI 1.324-507.391). Non-fatal cardiac arrest was also associated with higher mortality (p<0.001). There were no other significant differences in in-hospital mortality regarding risk factors, clinical presentation and aortic characteristics.

In our study, total in-hospital mortality in patients with type A AAD was 39.6%. Even in patients submitted to emergent cardiothoracic surgery, in-hospital mortality rate was 18.2%. In this group of patients, age and shock at admission were independent predictors of in-hospital mortality.