Department of Cardiology, Chiba Emergency Medical Center, Chiba, Japan.
Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
J Thorac Cardiovasc Surg. 2024 Feb;167(2):596-601.e3. doi: 10.1016/j.jtcvs.2022.03.016. Epub 2022 Mar 29.
Type A acute aortic dissection (AAD), especially that with coronary artery involvement and malperfusion, is a life-threatening disease. In the present study we aimed to investigate the association of surgical treatment and percutaneous coronary intervention (PCI) with in-hospital mortality in patients with type A AAD and coronary artery involvement.
This retrospective multicenter registry in Japan included 225 patients with type A AAD and coronary artery involvement. Treatment strategies including surgical treatment and/or PCI were left to treating physicians. The primary end point was in-hospital death.
Of 225 patients, dissection extended into the right and left coronary arteries and both in 115 (51.1%), 105 (46.7%), and 5 (2.2%), respectively. Overall, 94 (41.8%) patients died during the hospitalization. Coronary angiography was performed in 53 (23.6%) patients, among whom 39 (73.6%) underwent PCI. Surgical repair was performed in 188 (83.6%) patients. In patients who received neither procedure, 33 of 35 (94.3%) died during the hospitalization. PCI was performed as a bridge to surgical repair in 37 of 39 (94.9%) patients, and in-hospital mortality of patients who underwent PCI and surgical procedures was 24.3%. Multivariable analysis identified PCI and surgical procedures as factors associated with lower in-hospital mortality rates.
Coronary artery involvement in type A AAD was associated with high in-hospital mortality of more than 40% in the current era. An early reperfusion strategy with PCI as a bridge to surgical repair might improve clinical outcomes in this fatal condition.
A型急性主动脉夹层（AAD），尤其是合并冠状动脉受累和灌注不良者，是一种危及生命的疾病。本研究旨在探讨A型 AAD 合并冠状动脉受累患者接受手术治疗和经皮冠状动脉介入治疗（PCI）与院内死亡率的关系。
本研究是在日本进行的一项回顾性多中心登记研究，共纳入 225 例合并冠状动脉受累的 A 型 AAD 患者。治疗策略包括手术治疗和/或 PCI，由治疗医生决定。主要终点是院内死亡。
225 例患者中，夹层累及右冠状动脉和左冠状动脉及两者者分别为 115 例（51.1%）、105 例（46.7%）和 5 例（2.2%）。总的来说，94 例（41.8%）患者在住院期间死亡。53 例（23.6%）患者接受了冠状动脉造影检查，其中 39 例（73.6%）患者接受了 PCI。188 例（83.6%）患者接受了手术修复。未接受这两种治疗的 35 例患者中，33 例（94.3%）在住院期间死亡。39 例患者中有 37 例（94.9%）接受了 PCI 作为手术修复的桥梁，接受 PCI 和手术治疗的患者院内死亡率为 24.3%。多变量分析发现，PCI 和手术治疗是与较低院内死亡率相关的因素。
在当前时代，A型 AAD 合并冠状动脉受累与 40%以上的院内高死亡率相关。对于这种致命疾病，早期再灌注策略，即 PCI 作为手术修复的桥梁，可能改善临床结局。
