Early risk factors in acute type A aortic dissection: is there a predictor of preoperative mortality?

To describe the preoperative clinical, echocardiographic and biological findings in patients with acute aortic dissection and attempt to specify high risk factors of preoperative mortality.

A retrospective, monocentric study of 148 patients admitted for acute type A aortic dissection. All patients underwent a clinical, echocardiographic and biological evaluation on admission. In 75 patients, we measured serum cardiac troponin I (cTnI).

In hospital mortality was 25.9% and 15.6% presented with preoperative cardiac circulatory arrest (POCCA). Patients with POCCA were more likely than others to have hypotension (97+/-56 vs 144+/-24 mmHg, p<0.01) or shock (52% vs 3%, p<0.01) on admission. Pericardial effusion (65% vs 35%, p=0.01) and tamponade (61% vs 8%, p<0.01) were also significantly linked to POCCA but not the aortic ascendant diameter. Detection of cTnI was more frequent in patients with POCCA (24% vs 7%, p=0.051) and was found to be a good predictor of in hospital mortality (47% vs 14%, p<0.01).

For patients with acute type A aortic dissection, hypotension or shock on admission, pericardial effusion or tamponade, as well as cTnI detection, were the main predictors for POCCA and imply immediate surgery.