Gouveia E Melo Ryan, Machado Carolina, Caldeira Daniel, Alves Mariana, Lopes Alice, Serrano Maria, Fernandes E Fernandes Ruy, Mendes Pedro Luís
Vascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN). Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal.
Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal.
Int J Cardiol Heart Vasc. 2021 Dec 23;38:100934. doi: 10.1016/j.ijcha.2021.100934. eCollection 2022 Feb.
Acute Aortic dissection (AAD) may present as out-of-hospital cardiac arrest (OHCA). However, the incidence of this presentation is not well known. Our aim was to perform a systematic review and meta-analysis of all observational studies reporting on the incidence of AAD in patients with OHCA.
We searched MEDLINE, CENTRAL, PsycInfo, Web of Science Core Collection and OpenGrey databases from inception to March-2021, for observational studies reporting on the incidence of AAD in patients with OHCA. Data was pooled using a random-effects model of proportions. The primary outcome was the incidence of AAD in OHCA patients. Secondary outcomes were the incidence of type A aortic dissections (TAAD) and type B aortic dissections (TBAD) in OHCA patients, overall mortality following AAD-OHCA and risk of death in AAD-OHCA patients compared to risk of death of non-AAD-OHCA patients.
Fourteen studies were included. The pooled calculated incidence of OHCA due to AAD was 4.39% (95 %CI: 2.55; 6.8). Incidence of OHCA due to TAAD was 7.18% (95 %CI: 5.61; 8.93) and incidence of OHCA due to TBAD was 0.47% (95 %CI: 0.18; 0.85). Overall mortality following OHCA due to AAD was 100% (95 %CI: 97.62; 100). The risk of death in AAD-OHCA patients compared with non-AAD-OHCA patients was 1.10 (95 %CI: 0.94; 1.30).
AAD as a cause of OHCA is more frequent than previously thought. Prognosis is dire, as it is invariably lethal. These findings should lead to a higher awareness of AAD when approaching a patient with OHCA and to future studies on this matter.
急性主动脉夹层（AAD）可能表现为院外心脏骤停（OHCA）。然而，这种表现形式的发生率尚不清楚。我们的目的是对所有报告OHCA患者中AAD发生率的观察性研究进行系统评价和荟萃分析。
我们检索了MEDLINE、CENTRAL、PsycInfo、Web of Science核心合集和OpenGrey数据库，从创建到2021年3月，查找报告OHCA患者中AAD发生率的观察性研究。使用比例随机效应模型汇总数据。主要结局是OHCA患者中AAD的发生率。次要结局是OHCA患者中A型主动脉夹层（TAAD）和B型主动脉夹层（TBAD）的发生率、AAD-OHCA后的总体死亡率以及AAD-OHCA患者与非AAD-OHCA患者的死亡风险比较。
纳入14项研究。AAD导致的OHCA汇总计算发生率为4.39%（95%CI：2.55；6.8）。TAAD导致的OHCA发生率为7.18%（95%CI：5.61；8.93），TBAD导致的OHCA发生率为0.47%（95%CI：0.18；0.85）。AAD导致的OHCA后的总体死亡率为100%（95%CI：97.62；100）。AAD-OHCA患者与非AAD-OHCA患者相比的死亡风险为1.10（95%CI：0.94；1.30）。
AAD作为OHCA的病因比以前认为的更常见。预后很差，因为它总是致命的。这些发现应使在诊治OHCA患者时对AAD有更高的认识，并促使对此事进行进一步研究。
