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Syncope in acute aortic dissection: diagnostic, prognostic, and clinical implications.
Brahmajee K Nallamothu1, Rajendra H Mehta, Sanjay Saint
1University of Michigan Medical School, Ann Arbor, Michigan, USA.
The American Journal of Medicine
|November 13, 2002
Summary
Syncope in acute aortic dissection is linked to complications like cardiac tamponade and stroke. However, syncope itself does not independently increase mortality risk when these complications are accounted for.
Area of Science:
- Cardiology
- Vascular Surgery
- Emergency Medicine
Background:
- Syncope is a recognized symptom of acute aortic dissection.
- It often signals serious complications such as cardiac tamponade.
Purpose of the Study:
- To investigate the association between syncope and in-hospital mortality in patients with acute aortic dissection.
- To identify factors associated with syncope in this patient population.
Main Methods:
- A multinational study involving 728 patients with acute aortic dissection across 18 centers.
- Data collected via questionnaires, analyzed using multiple logistic regression models.
- Adjusted for demographics, dissection type, comorbidities, and complications like cardiac tamponade and stroke.
Main Results:
- Syncope occurred in 13% of patients and was associated with higher in-hospital mortality (34% vs. 23%).
- Patients with syncope were more likely to have cardiac tamponade (28% vs. 8%) and stroke (18% vs. 4%).
- Independently associated factors for syncope included proximal dissection, cardiac tamponade, and stroke.
Conclusions:
- Syncope in acute aortic dissection is strongly associated with complications like cardiac tamponade and stroke.
- When these specific complications are excluded, syncope alone does not independently predict an increased risk of death.