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Patient Factors Associated with 30-Day Mortality After Repair of Acute Type A Aortic Dissection
Thomas J. Martin1, Roshini K. Kalagara2, Neel R. Sodha1, Frank W. Sellke1, Afshin Ehsan1
1The Warren Alpert Medical School of Brown University, Providence, RI, USA, 2Icahn School of Medicine at Mount Sinai, New York, NY, USA

OBJECTIVE: Acute type A aortic dissection (ATAAD) is a cardiothoracic surgical emergency requiring immediate recognition by emergency department (ED) clinicians to minimize delays and reduce mortality. We hypothesized that hypotension on presentation was a significant marker for 30-day mortality following surgical repair of ATAAD at our center.
METHODS: A single-center, retrospective cohort study of patients undergoing surgical repair of ATAAD from 2002-2015 was performed; all available patients who did not withdraw care were included. Our primary outcome was all-cause mortality 30 days following surgery, and hypotension on admission was defined as systolic blood pressure (sBP) < 90 mmHg. Descriptive statistics were generated across groups, and odds ratios were adjusted for age, sex, sBP on presentation, as well as initial serum creatinine (mg/dL) and hematocrit (%).
RESULTS: We identified 54 patients for analysis and observed an overall 30-day mortality rate of 12.9% (n=7) (Table 1). On ED presentation, 13 (24.1%) patients were hypotensive with a 30-day mortality rate of 38.5% vs 4.9% among normotensive patients (p = 0.006). On multiple logistic regression (AUC = 0.84, p = 0.004), sBP was independently associated with 30-day mortality (aOR = 0.94, 95%CI [0.88, 0.99]). Each 10mmHg decrease in sBP was correlated with an 85.7% increased risk of 30-day mortality.
CONCLUSIONS: In this series of patients with ATAAD, sBP on presentation was strongly associated with 30-day mortality. Similar high-risk patients may benefit from earlier cardiothoracic intervention achieved via expedited transfer from community hospitals or direct transport by emergency medical services on suspicion of dissection.

Study Participant Characteristics (cont'd): IRQ (interquartile range)
Survived(n=47)Deceased(n=7)p value
Reported Symptoms
Chest Pain, n(%)32 (68.1)7 (100)0.17
Back Pain, n(%)15 (31.9)2 (28.6)>0.99
Extremity Numbness, n(%)10 (23.1)0 (0)0.33
Altered Mental Status, n(%)10 (23.1)2 (28.6)0.64
Time from Symptom to Presentation0.25
<6 hours, n(%)29 (61.7)2 (28.6)
6 to 24 hours, n(%)10 (21.3)3 (42.9)
>24 hours, n(%)8 (17.0)2 (28.6)

Study Participant Characteristics: IRQ (interquartile range), sBP (systolic blood pressure)
Survived (n=47)Deceased(n=7)p value
Presentation Characteristics
Age, years, median [IQR]60 [53, 72]65 [60, 77]0.13
Female, n(%)18 (38.3)3 (42.9)>0.99
White, n(%)36 (76.6)7 (100)0.33
History of Hypertension, n(%)42 (89.4)6 (85.7)0.67
Hypotensive on Admission (sBP<90mmHg), n(%)8 (17.0)5 (71.4)0.006
sBP, median [IQR]110 [90, 142]80 [70, 98]0.01
Hematocrit (%), median [IQR]39.1 [33.8, 42.4]39.0 [34.1, 42.4]0.80
Creatinine (mg/dL), median [IQR]1.1 [0.9, 1.4]1.3 [1.1, 2.1]0.066

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