Background: Acute type A aortic dissection(ATAAD) is life-threatening
and requires immediate surgery. Sudden chest pain may lead to a risk of
misdiagnosis as acute coronary syndrome and may lead to subsequent
antiplatelet therapy. We used the Chinese Acute Aortic Syndrome
Collaboration Database (AAS) to study the effects of antiplatelet
therapy (APT) on clinical outcomes. Methods: The AAS database is a
retrospective multicentre database where 31 of 3092 had APT with aspirin
or clopidogrel or both before surgery. Before and after propensity score
matching, the incidence of complications and mortality was compared
between APT and non-APT patients by using a logistic regression model.
The sample remaining after PSM was 30 in the APT group and 80 in the
non-APT group. Results: The sample remaining after matching was 30 in
the APT group and 80 in the non-APT group. We found 10 cases with
percutaneous coronary intervention in the APT group(33.3%). The APT
group received more volume of packed red blood cell (RBC), 8.4±6.05
units; plasma, 401.67±727 ml, and platelet transfusion(14.07±8.92
units). The drainage volume was much more in the APT group(
5009.37±2131.44ml, P=0.004). Mortality was higher in APT group(26% vs
10%, P=0.027). The preoperative APT was independent predictor of
mortality(OR 6.808, 95% CI1.554-29.828, P = 0.011). Conclusion: APT
prior to ATAAD repair was associated with more transfusions and higher
early mortality. The timing of surgery should be carefully considered
based on the patient’s status and the surgeon’s experience.
A Case of Acute Type A Aortic Dissection with Acute Coronary Syndrome : Left Main Stenting as a Bridge to Surgery
