Ischemia-Modified Albumin, a Novel Predictive Marker of In-Hospital Mortality in Acute Aortic Dissection Patients

Purpose: Type A acute aortic dissection (AAD) is an uncommon catastrophic cardiovascular disease with high pre-hospital mortality rate without timely and effectively treated. The aim of this study was to assess the value of serum platelet to hemoglobin (PHR) in predicting in-hospital mortality in type A AAD patients. Methods: A total of 183 type A AAD patients were included in this retrospective investigation from January 2017 to December 2019. Admission blood routine parameters were gathered and PHR was computed. The outcome was all-cause in-hospital mortality within 30 days. Results The average levels of serum PHR were significant higher in survivor group than those in non-survivor group (1.14 ± 0.57 vs 0.87 ± 0.47, p = 0.006) and serum PHR was an independent factor associated with in-hospital mortality (hazard ratio (HR): 2.831; 95% confidence interval (CI): 1.108–7.231; p = 0.030). ROC noted that 0.8723 was chosen as the ideal cutoff value with a sensitivity of 64.3% and specificity of 72.5%. In addition, the area under the ROC curve (AUC) was 0.693 (95% CI 0.599–0.787, p < 0.001). Conclusion: Admission serum PHR can be used as an independent predictor of in-hospital mortality in patients with type A AAD.

Download Full-text

P5599Prognostic impact of quality indicators on outcomes of acute aortic dissection in Japan

European Heart Journal ◽

10.1093/eurheartj/ehz746.0543 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T Yamaguchi ◽

M Nakai ◽

Y Sumita ◽

Y Miyamoto ◽

H Matsuda ◽

...

Keyword(s):

Aortic Dissection ◽

Hospital Mortality ◽

Quality Indicators ◽

Acute Aortic Dissection ◽

Vascular Diseases ◽

Type A ◽

Administrative Database ◽

Type B ◽

Practice Gaps

Abstract Background Despite recent advances in diagnosis and management, the mortality of acute aortic dissection (AAD) remains high. Purpose This study aims to develop quality indicators (QIs) for the management of AAD, and to evaluate the associations between QIs and outcomes of AAD in a Japanese nationwide administrative database. Methods A total of 18,348 patients suffered from AAD (Type A: 10,131, Type B: 8,217) in the Japanese Registry of All Cardiac and Vascular Diseases database between 2012 and 2015 were studied. A systematic review was performed to establish initial index items for QIs. Evaluation was performed through the expert consensus meeting using a Delphi method. Associations between developed QIs and the mortality were determined by multivariate mixed logistic regression analyses. Results A total of nine QIs (five structural and four processatic) were developed. Achievements of developed QIs (High: 7–9, Middle: 4–6, Low: 0–3) were significantly associated with lower in-hospital mortality even after adjustment for covariates in both type A (Middle: odds ratio [OR], 0.257; 95% confidence interval [CI], 0.211–0.312; P<0.001; High: OR, 0.064; 95% CI, 0.047–0.086; P<0.001 vs. Low) and type B (Middle: OR, 0.447; 95% CI, 0.338–0.590; P<0.001; High: OR, 0.128; 95% CI, 0.077–0.215; P<0.001 vs. Low). Additionally, achievements of structural and processatic QIs were consistently associated with reduced in-hospital mortality. QIs and in-hospital mortality Conclusions Developed QIs for AAD management were significantly associated with lower in-hospital mortality. Evaluation of each hospital's management with QIs could be helpful to equalize quality of treatment and to fill the evidence-to-practice gaps in the real-world treatment.

Download Full-text

Surgical outcomes of DeBakey type I and type II acute aortic dissection: a propensity score-matched analysis in 599 patients

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01594-9 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Chun-Yu Lin ◽

Tao-Hsin Tung ◽

Meng-Yu Wu ◽

Chi-Nan Tseng ◽

Feng-Chun Tsai

Keyword(s):

Propensity Score ◽

Aortic Dissection ◽

Hospital Mortality ◽

Acute Aortic Dissection ◽

Survival Rates ◽

Type I ◽

Acute Type ◽

Type Ii ◽

Matched Cohort ◽

Reoperation Rates

Abstract Background The DeBakey classification divides Stanford acute type A aortic dissection (ATAAD) into DeBakey type I (D1) and type II (D2) according to the extent of acute aortic dissection (AAD). This retrospective study aimed to compare the early and late outcomes of D1-AAD and D2-AAD through a propensity score-matched analysis. Methods Between January 2009 and April 2020, 599 consecutive patients underwent ATAAD repair at our institution, and were dichotomized into D1 (n = 543; 90.7%) and D2 (n = 56; 9.3%) groups. Propensity scoring was performed with a 1:1 ratio, resulting in a matched cohort of 56 patients per group. The clinical features, postoperative complications, 5-year cumulative survival and freedom from reoperation rates were compared. Results In the overall cohort, the D1 group had a lower rate of preoperative shock and more aortic arch replacement with longer cardiopulmonary bypass time. The D1 group had a higher in-hospital mortality rate than the D2 group in overall (15.8% vs 5.4%; P = 0.036) and matched cohorts (19.6% vs 5.4%; P = 0.022). For patients that survived to discharge, the D1 and D2 groups demonstrated similar 5-year survival rates in overall (77.0% vs 85.2%; P = 0.378) and matched cohorts (79.1% vs 85.2%; P = 0.425). The 5-year freedom from reoperation rates for D1 and D2 groups were 80.0% and 97.1% in overall cohort (P = 0.011), and 93.6% and 97.1% in matched cohort (P = 0.474), respectively. Conclusions Patients with D1-AAD had a higher risk of in-hospital mortality than those with D2-AAD. However, for patients who survived to discharge, the 5-year survival rates were comparable between both groups.

Download Full-text

Abstract 265: Extracorporeal Cardiopulmonary Resuscitation for Acute Aortic Dissection During Cardiac Arrest: A Nationwide Retrospective Observational Study

Circulation ◽

10.1161/circ.142.suppl_4.265 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Takayuki Ogura ◽

Hiroyuki Ohbe ◽

Hideo Yasunaga

Keyword(s):

Cardiac Arrest ◽

Cost Effectiveness ◽

Cardiopulmonary Resuscitation ◽

Aortic Dissection ◽

Hospital Mortality ◽

Acute Aortic Dissection ◽

Incremental Cost Effectiveness Ratio ◽

Cost Effectiveness Ratio ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Neurological Outcomes

Aim: Acute aortic dissection has been considered a contraindication for extracorporeal cardiopulmonary resuscitation (ECPR). However, studies are lacking regarding the epidemiology and effectiveness of ECPR for this condition. We aimed to examine whether ECPR for acute aortic dissection during cardiac arrest is effective or not. Methods: Using the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2018, we identified all emergently hospitalized adults who received ECPR on the day of admission. ECPR was defined as receiving both chest compressions and percutaneous extracorporeal membrane oxygenation on the day of hospital admission. In-hospital mortality and neurological outcomes were compared between patients with and without acute aortic dissection. We also calculated the incremental cost-effectiveness ratio of ECPR for acute aortic dissection. Results: We identified 10,238 patients who received ECPR on the day of admission. Of these, 398 patients (3.9%) had acute aortic dissection. In-hospital mortality was 98% in the acute aortic dissection group and 79% in the non-acute aortic dissection group. Seven patients (1.8%) in the acute aortic dissection group survived to discharge after ECPR; of these, six patients had good neurological outcomes at discharge. The incremental cost-effectiveness ratio of ECPR for patients with acute aortic dissection was estimated at 159,337 US dollars per quality-adjusted life year gained. Conclusion: ECPR successfully rescued a small number of acute aortic dissection patients with cardiac arrest; however, the cost burden of ECPR for acute aortic dissection patients was unacceptably high.

Download Full-text

Ischemia-Modified Albumin As a Marker for Acute Aortic Dissection: A Prospective Observational Study

10.21203/rs.3.rs-588867/v1 ◽

2021 ◽

Author(s):

Yang zhou ◽

Xiangping Chai ◽

Huaping He ◽

Wen Peng ◽

Guifang Yang ◽

...

Keyword(s):

Aortic Dissection ◽

Prospective Observational Study ◽

Acute Aortic Dissection ◽

Area Under The Curve ◽

Cost Effective ◽

Final Diagnosis ◽

Net Benefit ◽

Ischemia Modified Albumin ◽

Potential Biomarker ◽

Cobalt Binding

Abstract Background: Delayed or misdiagnosed aortic dissection can lead to death and morbidity. Ischemia-modified albumin (IMA) measures the cobalt binding capability and has been associated with mortality in patients with acute aortic dissection (AAD). However, it is unknown whether IMA levels can differentiate AAD in patients with chest pains.Methods: A total of 100 suspected AAD patients were enrolled in this study. A cobalt-binding assay was used to determine the plasma IMA levels. In addition, the IMA levels of patients in different groups were compared based on the final diagnosis. Results: IMA levels were significantly higher in the AAD group than in the AMI, PE, and other groups (63.98 ± 14.38, 52.57 ± 9.54, 49.26 ± 10.99, 37.99 ± 6.59, respectively) within 24 hours after the onset of symptoms. The area under the curve (AUC) based on the IMA level was 0.810 (95% CI, 0.708–0.897), and the best threshold of IMA was 59.35 u/ml (specificity, 85.7% and sensitivity, 66%). The decision and clinical impact curves indicated that the IMA had an excellent standardized net benefit and could be suitable for patient diagnosis.Conclusion: IMA is elevated in AAD patients. The IMA levels have better performance for AAD than D-dimer and could be a potential biomarker with rapid and cost-effective diagnostic tests for early diagnosis of AAD. However, large-sample studies are needed to verify the findings.

Download Full-text

Predictive Value of D-dimer on Mortality in Patients with Acute Aortic Dissection

10.21203/rs.3.rs-114655/v1 ◽

2020 ◽

Author(s):

Shuangshuang Li ◽

Pengcheng Du ◽

Jian Dong ◽

Jian Zhou ◽

Zaiping Jing

Keyword(s):

Sensitivity Analysis ◽

Aortic Dissection ◽

Confidence Interval ◽

Hospital Mortality ◽

Publication Bias ◽

Odds Ratio ◽

Acute Aortic Dissection ◽

Meta Analysis ◽

Cutoff Value ◽

D Dimer

Abstract ObjectiveTo clarify the relation between D-dimer and in-hospital mortality of acute aortic dissection, a meta-analysis was performed by summarizing all relevant studies.MethodsAll related studies were retrieved and identified in PubMed and Embase databases. Precise data was extracted from standard articles, such as sample size, odds ratio, and 95% confidence interval. Then pooled odds ratio (OR) accompanying 95% confidence interval (CI) were calculated using random model. Study heterogeneity examined by Q text and I2 statistic. Sensitivity analysis was performed to assess the stability of the results. Publication bias was assessed by Egger’s test. ResultsTen studies (1954 patients) that met the inclusion criteria were included in this review. The results suggested a link between D-dimer and in-hospital mortality of acute aortic dissection (OR=1.17 95%CI=1.08-1.27). With higher of cutoff value of D-dimer, the closer for the mortality of AAD, with ORs (95% CIs) ranging from 1.13(1.09–1.16) to 4.12 (1.56–10.93). The relationship was also found in six Type A AAD studies without heterogeneity (OR=1.13 95%CI=1.08-1.18). According to sensitivity analysis, the link was stable after exclusion of one study at a time. Publication bias was find among studies (P=0.02). ConclusionsThe result of this meta-analysis indicated that D-dimer maybe a predictor in-hospital mortality of acute aortic dissection patients. What’s more, the higher of cutoff value of D-dimer, the stronger for the predictive ability.

Download Full-text

Prevalence, Clinical Features, and In-hospital Outcome of Fatty Liver Disease in Acute Aortic Dissection: A Single-Center Retrospective Study

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.698285 ◽

2021 ◽

Vol 8 ◽

Author(s):

Yifan Zuo ◽

Xin Cai ◽

Zhiwei Wang ◽

Zhipeng Hu ◽

Zhiyong Wu ◽

...

Keyword(s):

Liver Disease ◽

Aortic Dissection ◽

Hospital Mortality ◽

Fatty Liver ◽

Clinical Features ◽

Fatty Liver Disease ◽

Acute Aortic Dissection ◽

Type A ◽

Type B ◽

Hospital Outcome

Background and Aims: Fatty liver disease (FLD) has emerged as a major public issue in China. We aim to investigate prevalence, clinical features, and in-hospital outcome of FLD in acute aortic dissection (AAD) patients.Methods: Data of 379 AAD patients from 2017 to 2019 at Renmin hospital of Wuhan University was retrospectively collected and divided according to age and FLD absence. Propensity score matching was used for minimal confounding. We compared their physical environmental parameter of onset, clinical features, and in-hospital outcome.Results: The mean age was 52.0 ± 11.5 years in type A and 55.1 ± 11.4 in type B. 25.0% of type A and 19.2% of type B AAD patients had FLD. Logistic regression indicated a negative association between FLD and age, both in type A [unadjusted odds ratio (OR) 0.958 (per 1 year), 95% confidence interval (CI) 0.930–0.988, p = 0.0064] and type B [unadjusted OR 0.943 (per 1 year), 95% CI 0.910–0.978, p = 0.0013]. After matching, type A with FLD had onset with a lower air quality index (AQI) of 68.5 [interquartile range (IQR) 46.0–90.0] and a lower Pm 2.5 concentration of 36.0 μg/m3 (IQR 23.0–56.0) compared with non-FLD group. In Kaplan-Meier estimation, FLD was associated with higher risk of in-hospital mortality in type B AAD (p = 0.0297).Conclusion: The prevalence of FLD in AAD decrease with age, both in type A and type B AAD. Type A AAD patients with FLD had onset with better air quality parameters compared with non-FLD group. FLD was associated with higher risk of in-hospital mortality in type B AAD.

Download Full-text

P5607Clinical characteristics and treatment strategy for acute aortic dissection in Tokyo Acute Aortic Disease Super-Network System

European Heart Journal ◽

10.1093/eurheartj/ehz746.0551 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

H Yoshino ◽

K Akutsu ◽

T Takahashi ◽

T Shimokawa ◽

H Ogino ◽

...

Keyword(s):

Aortic Dissection ◽

Hospital Mortality ◽

Treatment Strategy ◽

Acute Aortic Dissection ◽

False Lumen ◽

Type A ◽

Network System ◽

Care Hospital ◽

Type B ◽

New System

Abstract Introduction Acute aortic dissection (AAD) is one of the most fatal cardiovascular diseases. The prevalence of AAD is reported to be low. The clinical data of AAD from representative cardiovascular centers are not enough to show the whole range of clinical feature of AAD. We have to know the exact prevalence and clinical pictures of AAD under the new system, the Tokyo AAD Super-Network System (TAAD-SNS), for strategy of emergency transport and treatment of AAD which would cover the entire metropolitan area of Tokyo. TAAD-SNS started in 2011, and after slight modification, the new system of AAD re-started in 2013. The aim of this study is to elucidate the whole range of clinical characteristics and recent trends of treatment of AAD. Methods Out of 73 hospitals included in Tokyo CCU Network system, 41 hospitals are chosen for TAAD-SNS. These hospitals provide around-the-clock surgery. In this system, the availability of surgical division is monitored in real time. All of the patients suspected of AAD are transferred directly or from primary care hospital to the hospitals of TAAD-SNS. Results After exclusion of 237 patients with cardiopulmonary arrest on arrival, 4877 consecutive patients (2923 male, mean age of 69±14 y/o) were admitted to the hospitals with diagnosis of AAD from 2013 to 2016. Prevalence of AAD in Tokyo was about 10 patients per 100,000 populations in every year. After exclusion of 37 patients undetermined into type A or B, 4840 patients (2694 with type A and 2146 with type B) were analyzed. Among the type A patients, 1752 (65%) were classified into type of patent false lumen (classic-type), 721 (27%) of closed false lumen (intramural hematoma: IMH-type), and 221 (8%) were undetermined. Among the type B, 880 (41%) were classified into classic-type, 1129 (53%) of IMH-type, and 137 (6%) were undetermined. Both among type A and B, mean ages were younger in classic-type than in IMH-type (type A: 66±14 vs. 73±12 y/o, p<0.05; type B: 64±15 vs. 72±12 y/o, p<0.05). Prevalence of male population and risk factor of hypertension was higher in type B than in type A both among classic-type and IMH-type. Systolic blood pressure at the emergency room was lower in type A than in type B among both classic-type and IMH-type (classic-type: 124±34 vs. 161±38 mmHg, IMH-type: 130±51 vs. 163±56 mmHg). In-hospital mortality of surgical treatment for type A classic-type and type A IMH-type, conservative strategy for type B classic-type and type B IMH-type was 9.6%, 4.2%, 3.1% and 1.7%, respectively. Stentgraft implantation for type B AAD started and shows a favorable in-hospital mortality compared to the operative treatment (Stentgraft vs. surgery in type B classic-type: 7.8% vs. 6.5%, in type B IMH-type: 10.7% vs. 11.8%, respectively). Conclusion Our study showed that prevalence of AAD was 2–3 times higher than previous reports. We should consider to choose the treatment strategy according to the type of AAD, A or B, classic-type or IMH-type. Acknowledgement/Funding Tokyo Metropolitan government

Download Full-text

Incidence and risk factors of recurrent pain in acute aortic dissection and in-hospital mortality

VASA ◽

10.1024/0301-1526/a000704 ◽

2018 ◽

Vol 47 (4) ◽

pp. 301-310

Author(s):

Dilixiati Siti ◽

Asiya Abudesimu ◽

Xiaojie Ma ◽

Lei Yang ◽

Xiang Ma ◽

...

Keyword(s):

Risk Factors ◽

Aortic Dissection ◽

Hospital Mortality ◽

Acute Aortic Dissection ◽

Emergency Operation ◽

Type A ◽

Type B ◽

Recurrent Pain ◽

Group I ◽

Group Ii

Abstract. Background: We investigated the prevalence of recurrent pain and its relationship with in-hospital mortality in acute aortic dissection (AAD). Patients and methods: Between 2011 and 2016, 234 AAD patients were selected. Recurrent pain was defined as a mean of VAS > 3, within 48 hours following hospital admission or before emergency operation. Patients with and without recurrent pain were divided into group I and group II, respectively into type A AAD and type B AAD patients. Our primary outcome was in-hospital mortality. Results: The incidence of recurrent pain was 24.4 % in AAD patients. Incidence of recurrent pain was higher in type A AAD patients than type B AAD patients (48.9 vs. 9.6 %). Overall in-hospital mortality was 25.6 %. Type A AAD had a higher in-hospital mortality than type B AAD patients (47.7 vs. 12.3 %). Group I had significantly higher in-hospital mortality than group II (type A: 79.1 vs. 17.8 %; type B: 57.1 vs. 7.6 %, all P < 0.001), as was the case with medical managed patients (type A: 72.1 vs. 13.3 %; type B: 35.7 vs. 2.3 %, all P < 0.001). Logistic regression analysis showed that use of one drug alone and waist pain were predictive factors for recurrent pain in type A AAD and type A AAD patients, respectively (OR 3.686, 95 % CI: 1.103~12.316, P = 0.034 and OR 14.010, 95 % CI: 2.481~79.103, P = 0.003). Recurrent pains were the risk factors (type A: OR 11.096, 95 % CI: 3.057~40.280, P < 0.001; type B: OR 14.412, 95 % CI: 3.662~56.723, P < 0.001), while invasive interventions were protective (type A: OR 0.133, 95 % CI: 0.035~0.507, P < 0.001; type B: OR 0.334, 95 % CI: 0.120~0.929, P = 0.036) for in-hospital mortality in AAD patients. Conclusions: Approximately one-fourth of AAD patients presented with recurrent pains, which might increase in-hospital mortality. Thus, interventional strategies at early stages are important.

Download Full-text