Bossone Eduardo, Rampoldi Vincenzo, Nienaber Christoph A, Trimarchi Santi, Ballotta Andrea, Cooper Jeanna V, Smith Dean E, Eagle Kim A, Mehta Rajendra H
Division of Cardiology and Vascular Surgery, San Donato Hospital, Milan, Italy.
Am J Cardiol. 2002 Apr 1;89(7):851-5. doi: 10.1016/s0002-9149(02)02198-7.
Vascular compromise seen with pulse deficits is common in patients with type A dissection. However, patient characteristics and in-hospital outcomes associated with pulse deficits have not been evaluated. Accordingly, we studied 513 patients (mean age 62 +/- 14 years, 65% men) with acute type A aortic dissection enrolled in the International Registry of Acute Aortic Dissection. Pulse deficits, defined as decreased or absent carotid or peripheral pulses as noted by clinicians and later confirmed by diagnostic imaging, at surgery or at autopsy were noted in 154 patients (30%). Age <70 years, male gender, neurologic deficit(s), altered mental status, and hypotension, shock, or tamponade on admission were all significantly higher in patients with than without pulse deficits. The etiology of aortic dissection, clinical symptoms, and imaging findings were similar in the 2 groups. In-hospital complications (hypotension, coma, renal failure, and limb ischemia) and mortality (41% vs 25%, p = 0.0002) were significantly higher in patients with pulse deficit. Cox proportional-hazards regression analysis identified pulse deficit as an independent predictor of 5-day in-hospital mortality (risk ratio 2.73, 95% confidence interval 1.7 to 4.4; p <0.0001). Further, overall mortality rates increased with an increasing number of pulse deficits (p for trend <0.0001). Pulse deficits are common findings in patients with type A aortic dissection and identify those at high risk of in-hospital adverse events. This simple clinical sign should direct physicians to consider a diagnosis of aortic dissection in patients with acute chest pain, and should help identify a subgroup of patients who would benefit from more aggressive strategies.
脉搏缺失所致的血管受压在A型主动脉夹层患者中很常见。然而，与脉搏缺失相关的患者特征及院内结局尚未得到评估。因此，我们对国际急性主动脉夹层注册研究中纳入的513例急性A型主动脉夹层患者（平均年龄62±14岁，65%为男性）进行了研究。154例患者（30%）存在脉搏缺失，定义为临床医生发现并经诊断性影像学检查、手术或尸检证实的颈动脉或外周脉搏减弱或消失。有脉搏缺失的患者年龄<70岁、男性、存在神经功能缺损、精神状态改变以及入院时低血压、休克或心包填塞的比例均显著高于无脉搏缺失的患者。两组患者的主动脉夹层病因、临床症状及影像学表现相似。有脉搏缺失的患者院内并发症（低血压、昏迷、肾衰竭和肢体缺血）及死亡率（41%对25%，p = 0.0002）显著更高。Cox比例风险回归分析确定脉搏缺失是住院5天死亡率的独立预测因素（风险比2.73，95%置信区间1.7至4.4；p <0.0001）。此外，总体死亡率随脉搏缺失数量的增加而升高（趋势p <0.0001）。脉搏缺失在A型主动脉夹层患者中很常见，可识别出院内发生不良事件风险高的患者。这一简单的临床体征应促使医生在急性胸痛患者中考虑主动脉夹层的诊断，并有助于识别出能从更积极治疗策略中获益的患者亚组。
