Zhou Li-Ping, Li Xiang-Min, Huang Guo-Qing, Zhang Fang-Jie
Department of Emergency Medicine, Xiangya Hospital, National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Central South University, 410008 Changsha, Hunan, China.
Rev Cardiovasc Med. 2023 Jun 6;24(6):164. doi: 10.31083/j.rcm2406164. eCollection 2023 Jun.
The aim of this study was to determine the clinical characteristics and outcome of patients with aortic dissection (AD) who present with an initial manifestation of cerebral infarction.
We retrospectively analyzed patients who were diagnosed with AD and admitted to the emergency department from May 1, 2017 to May 1, 2022. Data was collected for variables including age, sex, clinical manifestation, past medical history, and laboratory test results.
Twenty-five patients (2.61%, 22 type A and 3 type B) showed cerebral infarction as the primary presentation for acute AD, while another 933 AD patients (471 type A and 462 type B) who presented with other symptoms served as the control group. Eighteen of the 25 patients (72%) were initially diagnosed with stroke, and the diagnosis of AD was missed. However, patients with a missed diagnosis of AD did not have significantly different mortality to those in whom AD was diagnosed (chi-square test, 0.9999). Patients with cerebral infarction as the first presentation had a higher incidence of type A AD than the control patients ( = 0.0002), while their mortality rate was also higher than the control group of AD patients ( 0.0001). Furthermore, patients with cerebral infarction as the first presentation were more likely to have multiple organ dysfunction.
AD with an initial presentation of cerebral infarction is a rare condition with high mortality. However, the initial failure to diagnose AD does not further increase patient mortality.
本研究旨在确定以脑梗死为首发表现的主动脉夹层（AD）患者的临床特征及预后。
我们回顾性分析了2017年5月1日至2022年5月1日期间诊断为AD并入住急诊科的患者。收集了包括年龄、性别、临床表现、既往病史和实验室检查结果等变量的数据。
25例患者（2.61%，22例A型和3例B型）以脑梗死作为急性AD的主要表现，另外933例出现其他症状的AD患者（471例A型和462例B型）作为对照组。25例患者中有18例（72%）最初被诊断为中风，AD诊断被漏诊。然而，AD漏诊患者的死亡率与确诊AD的患者相比无显著差异（卡方检验，P = 0.9999）。以脑梗死为首发表现的患者中A型AD的发生率高于对照组患者（P = 0.0002），其死亡率也高于AD对照组患者（P = 0.0001）。此外，以脑梗死为首发表现的患者更易出现多器官功能障碍。
以脑梗死为首发表现的AD是一种罕见且死亡率高的疾病。然而，最初未能诊断出AD并不会进一步增加患者死亡率。
