Abstract
Background
Acute coronary artery involvement (ACI) is a lethal complication of acute type A aortic dissection. Although ACI has been reported as one of the prognostic factors of acute type A aortic dissection, it does not always cause coronary ischemia. The extent of myocardial damage varies from case to case. Moreover, since the definition of ACI varies from paper to paper, it is unknown what the difference is between ACI with and without myocardial necrosis. In general, it can be assumed that cases with myocardial infarction have worse results. However, it is unknown how poor ACI is with myocardiac ischemia and how optimistic it is without it. This study compared the surgical results between the two groups of ACI with or without myocardiac ischemia.
Methods
Among 348 patients who underwent an emergency operation for acute type A aortic dissection, there were 28 (8.0%) patients complicated by ACI and underwent additional coronary artery bypass grafting. We divided 26 of those patients into two groups; the MI group ( with CK-MB elevation) and the NMI group (without CK-MB elevation) and compared both groups.
Results
Of the 26, sixteen were in the MI group, and ten were in the NMI group. The average CK-MB in the MI group was 225.5 IU/L, and that in the NMI group was 13.5 IU/L. The mean time from onset to surgery was 248 minutes in the MI group, 250 minutes in the NMI group. There was statistical significance in mortality ( 69% vs. 13%, p=0.03). There was no significance in major complications (ICU days, reintubation, reoperation, pneumonia, sepsis).
Conclusions
Acute coronary artery involvement was associated with 8.0% of patients with ATAAD, and 62% of them had myocardial ischemia with CK-MB elevation. As expected, the MI group had significantly higher mortality than the NMI group. It is crucial for cases with suspected ACI to obtain coronary perfusion as soon as possible to prevent CK-MB from elevationg.
The Impact of CK-MB Elevation in Patients With Acute Type A Aortic Dissection With Coronary Artery Involvement