急性 A 型主动脉夹层患者的卒中及转归。
Stroke and outcomes in patients with acute type A aortic dissection.
机构信息
Department of Cardiology, University of Salerno, Salerno, Italy (E.B.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI (D.C.C., E.K.-R., D.G.M., K.A.E.); Abbott-Northwestern Hospital, Minneapolis Heart Institute, Minneapolis, MN (K.M.H.); Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan (T.S.); Department of Interventional Cardiology, San Salvatore Hospital, Pesaro, Italy (R.F.); Department of Cardiac Sciences, University of Calgary, Calgary, Canada (S.H.); Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria (M.P.E.); Division of Medical Genetics, University of Pennsylvania, Philadelphia, PA (R.E.P.); Department of Cardiology, Hôpital Bichat, Paris, France (P.G.S.); Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN (K.G.); Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain (A.E.); Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA (E.M.I.); and Department of Internal Medicine, University of Rostock, Rostock, Germany (C.A.N.).
出版信息
Circulation. 2013 Sep 10;128(11 Suppl 1):S175-9. doi: 10.1161/CIRCULATIONAHA.112.000327.
BACKGROUND
Stroke is a highly dreaded complication of type A acute aortic dissection (TAAAD). However, little data exist on its incidence and association with prognosis.
METHODS AND RESULTS
We evaluated 2202 patients with TAAAD (mean age 62 ± 14 years, 1487 [67.5%] men) from the International Registry of Acute Aortic Dissection to determine the incidence and prognostic impact of stroke in TAAAD. Stroke was present at arrival in 132 (6.0%) patients with TAAAD. These patients were older (65 ± 12 versus 62 ± 15 years; P=0.002) and more likely to have hypertension (86% versus 71%; P=0.001) or atherosclerosis (29% versus 22%; P=0.04) than patients without stroke. Chest pain at arrival was less common in patients with stroke (70% versus 82%; P<0.001), and patients with stroke presented more often with syncope (44% versus 15%; P<0.001), shock (14% versus 7%; P=0.005), or pulse deficit (51% versus 29%; P ≤ 0.001). Arch vessel involvement was more frequent among patients with stroke (68% versus 37%; P<0.001). They had less surgical management (74% versus 85%; P<0.001). Hospital stay was significantly longer in patients with stroke (median 17.9 versus 13.3 days; P<0.001). In-hospital complications, such as hypotension, coma, and malperfusion syndromes, and in-hospital mortality (adjusted odds ratio, 1.62; 95% confidence interval, 0.99-2.65) were higher among patients with stroke. Among hospital survivors, follow-up mortality was similar between groups (adjusted hazard ratio, 1.15; 95% confidence interval, 0.46-2.89).
CONCLUSIONS
Stroke occurred in >1 of 20 patients with TAAAD and was associated with increased in-hospital morbidity but not long-term mortality. Whether aggressive early invasive interventions will reduce negative outcomes remains to be evaluated in future studies.
背景
中风是急性 A 型主动脉夹层（TAAAD）的一种严重并发症。然而，关于其发病率和与预后的关系的数据很少。
方法和结果
我们评估了来自国际急性主动脉夹层注册中心的 2202 例 TAAAD 患者（平均年龄 62 ± 14 岁，1487 [67.5%] 名男性），以确定 TAAAD 中风的发生率和预后影响。132 例（6.0%）TAAAD 患者入院时即有中风。这些患者年龄较大（65 ± 12 岁比 62 ± 15 岁；P=0.002），且更可能患有高血压（86%比 71%；P=0.001）或动脉粥样硬化（29%比 22%；P=0.04）。与无中风的患者相比，入院时有胸痛的患者较少（70%比 82%；P<0.001），且中风患者更常出现晕厥（44%比 15%；P<0.001）、休克（14%比 7%；P=0.005）或脉搏缺失（51%比 29%；P ≤ 0.001）。中风患者的弓状血管受累更常见（68%比 37%；P<0.001）。他们接受的手术治疗较少（74%比 85%；P<0.001）。中风患者的住院时间明显更长（中位数 17.9 天比 13.3 天；P<0.001）。低血压、昏迷和灌注不良综合征等院内并发症和院内死亡率（调整后优势比，1.62；95%置信区间，0.99-2.65）在中风患者中更高。在住院存活者中，两组间的随访死亡率相似（调整后危险比，1.15；95%置信区间，0.46-2.89）。
结论
TAAAD 患者中超过 1/20 发生中风，且与院内发病率增加相关，但与长期死亡率无关。积极的早期侵袭性干预是否会降低不良结局，仍有待未来研究评估。
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