• J. Thorac. Cardiovasc. Surg. · Feb 2024

    Multicenter Study

    Treatment strategies and in-hospital mortality in patients with type A acute aortic dissection and coronary artery involvement.

    • Osamu Hashimoto, Yuichi Saito, Haruka Sasaki, Keita Yumoto, Susumu Oshima, Tetsuya Tobaru, Junji Kanda, Yoshiaki Sakai, Satoshi Yasuda, and Angina Pectoris-Myocardial Infarction Multicenter Investigators.
    • Department of Cardiology, Chiba Emergency Medical Center, Chiba, Japan.
    • J. Thorac. Cardiovasc. Surg. 2024 Feb 1; 167 (2): 596601.e3596-601.e3.

    ObjectiveType A acute aortic dissection (AAD), especially that with coronary artery involvement and malperfusion, is a life-threatening disease. In the present study we aimed to investigate the association of surgical treatment and percutaneous coronary intervention (PCI) with in-hospital mortality in patients with type A AAD and coronary artery involvement.MethodsThis retrospective multicenter registry in Japan included 225 patients with type A AAD and coronary artery involvement. Treatment strategies including surgical treatment and/or PCI were left to treating physicians. The primary end point was in-hospital death.ResultsOf 225 patients, dissection extended into the right and left coronary arteries and both in 115 (51.1%), 105 (46.7%), and 5 (2.2%), respectively. Overall, 94 (41.8%) patients died during the hospitalization. Coronary angiography was performed in 53 (23.6%) patients, among whom 39 (73.6%) underwent PCI. Surgical repair was performed in 188 (83.6%) patients. In patients who received neither procedure, 33 of 35 (94.3%) died during the hospitalization. PCI was performed as a bridge to surgical repair in 37 of 39 (94.9%) patients, and in-hospital mortality of patients who underwent PCI and surgical procedures was 24.3%. Multivariable analysis identified PCI and surgical procedures as factors associated with lower in-hospital mortality rates.ConclusionsCoronary artery involvement in type A AAD was associated with high in-hospital mortality of more than 40% in the current era. An early reperfusion strategy with PCI as a bridge to surgical repair might improve clinical outcomes in this fatal condition.Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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