Wang Zhigang, Ge Min, Chen Tao, Chen Cheng, Zong Qiuyan, Lu Lichong, Wang Dongjin
Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
J Thorac Dis. 2020 Nov;12(11):6618-6628. doi: 10.21037/jtd-20-2336.
To explore the clinical characteristics and prognosis of patients with hypertension underwent emergency surgery for type A acute aortic dissection (TA-AAD).
The present study enrolled 712 consecutive patients diagnosed with TA-AAD and received aortic repair surgery at our hospital between January 2014 to December 2018. Clinical characteristics of enrolled patients were retrospectively reviewed. Patients were grouped by preexisting hypertension history and matched with propensity scores matching method. Patients' clinical characteristics were compared and analyzed before and after propensity scoring. To identify predictors for long-term mortality rate, Kaplan-Meier survival estimation and Cox proportional hazard analysis were performed.
A total of 492 patients (69.1% of all patients in the cohort) were included in the hypertensive group and they had increased age and weight compared to patients in the non-hypertensive group. Between two groups, preoperative leukocyte count and serum creatinine level were found significant different (P<0.05). After propensity scoring, 128 pairs (256 patients) were successfully matched. Our analysis showed that there was no significant difference of ventilation duration, 30-day mortality rate, intensive care unit stay and hospitalization time between two groups. However, our data suggested that hypertensive patients presented with less intra-operative aortic valve involvement. There was a significant difference in long-term survival rate (P=0.037) between two groups. Cox regression analysis demonstrated that hypertension was an independent risk factor [hazard ratio (HR), 3.040; 95% confidence interval (CI), 1.124-8.227; P=0.029].
Our data suggested that TA-AAD patients complicated with hypertension had increased age and weight compared to non-hypertensive patients. Concomitant hypertension identified upon hospital administration was an independent risk factor for long-term survival in TA-AAD patients while did not influence the 30-day mortality rate.
探讨高血压患者行A型急性主动脉夹层（TA-AAD）急诊手术的临床特征及预后。
本研究纳入了2014年1月至2018年12月期间在我院连续诊断为TA-AAD并接受主动脉修复手术的712例患者。回顾性分析纳入患者的临床特征。根据既往高血压病史对患者进行分组，并采用倾向评分匹配法进行匹配。在倾向评分前后对患者的临床特征进行比较和分析。为了确定长期死亡率的预测因素，进行了Kaplan-Meier生存估计和Cox比例风险分析。
高血压组共纳入492例患者（占队列中所有患者的69.1%），与非高血压组患者相比，他们的年龄和体重有所增加。两组之间，术前白细胞计数和血清肌酐水平存在显著差异（P<0.05）。倾向评分后，成功匹配了128对（256例患者）。我们的分析表明，两组之间的通气时间、30天死亡率、重症监护病房停留时间和住院时间没有显著差异。然而，我们的数据表明，高血压患者术中主动脉瓣受累较少。两组之间的长期生存率存在显著差异（P=0.037）。Cox回归分析表明，高血压是一个独立的危险因素[风险比（HR），3.040；95%置信区间（CI），1.124-8.227；P=0.029]。
我们的数据表明，与非高血压患者相比，TA-AAD合并高血压患者的年龄和体重增加。入院时发现的合并高血压是TA-AAD患者长期生存的独立危险因素，而不影响30天死亡率。
