Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA.
Circulation. 2011 Nov 1;124(18):1911-8. doi: 10.1161/CIRCULATIONAHA.110.006320. Epub 2011 Oct 3.
In acute aortic dissection, delays exist between presentation and diagnosis and, once diagnosed, definitive treatment. This study aimed to define the variables associated with these delays.
Acute aortic dissection patients enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and January 2007 were evaluated for factors contributing to delays in presentation to diagnosis and in diagnosis to surgery. Multiple linear regression was performed to determine relative delay time ratios (DTRs) for individual correlates. The median time from arrival at the emergency department to diagnosis was 4.3 hours (quartile 1-3, 1.5-24 hours; n=894 patients) and from diagnosis to surgery was 4.3 hours (quartile 1-3, 2.4-24 hours; n=751). Delays in acute aortic dissection diagnosis occurred in female patients; those with atypical symptoms that were not abrupt or did not include chest, back, or any pain; patients with an absence of pulse deficit or hypotension; or those who initially presented to a nontertiary care hospital (all P<0.05). The largest relative DTRs were for fever (DTR=5.11; P<0.001) and transfer from nontertiary hospital (DTR=3.34; P<0.001). Delay in time from diagnosis to surgery was associated with a history of previous cardiac surgery, presentation without abrupt or any pain, and initial presentation to a nontertiary care hospital (all P<0.001). The strongest factors associated with operative delay were prolonged time from presentation to diagnosis (DTR=1.35; P<0.001), race other than white (DTR=2.25; P<0.001), and history of coronary artery bypass surgery (DTR=2.81; P<0.001).
Improved physician awareness of atypical presentations and prompt transport of acute aortic dissection patients could reduce crucial time variables.
在急性主动脉夹层中，从出现症状到确诊以及确诊后进行确定性治疗之间存在时间延迟。本研究旨在确定与这些延迟相关的变量。
对 1996 年至 2007 年 1 月期间国际急性主动脉夹层注册研究（IRAD）纳入的急性主动脉夹层患者进行评估，以确定导致从出现症状到确诊以及从确诊到手术的时间延迟的因素。采用多元线性回归确定各相关因素的相对延迟时间比（DTR）。从到达急诊科到确诊的中位时间为 4.3 小时（四分位距 1-3，1.5-24 小时；n=894 例患者），从确诊到手术的中位时间为 4.3 小时（四分位距 1-3，2.4-24 小时；n=751 例患者）。女性患者的急性主动脉夹层诊断存在延迟；症状不典型，不包括胸痛、背痛或任何疼痛；无脉搏缺失或低血压；或最初就诊于非三级护理医院（均 P<0.05）。最大的相对 DTR 见于发热（DTR=5.11；P<0.001）和从非三级医院转院（DTR=3.34；P<0.001）。从确诊到手术的时间延迟与既往心脏手术史、无突然或任何疼痛出现以及最初就诊于非三级护理医院相关（均 P<0.001）。与手术延迟相关的最强因素是从出现症状到确诊的时间延长（DTR=1.35；P<0.001）、非白人种族（DTR=2.25；P<0.001）和冠状动脉旁路移植术史（DTR=2.81；P<0.001）。
提高医生对不典型表现的认识并及时转运急性主动脉夹层患者，可能会缩短这些关键的时间变量。
