Nationwide trends in outcomes and resource utilization in surgically treated acute type A aortic dissection with coronary malperfusion

Background: Coronary malperfusion (CM) is a life-threatening complication of acute type A aortic dissection (ATAAD) that has been associated with poor outcomes. Although overall surgical outcomes for ATAAD have improved over time, contemporary nationwide trends in mortality and the associated use of intensive care unit (ICU)-level resources among patients with CM remain incompletely characterized. Methods: We conducted a retrospective cohort study using the Japanese Diagnosis Procedure Combination database from July 2010 to March 2022. Patients who underwent emergency surgery for ATAAD on the day of admission were included. CM was defined by a diagnosis of acute myocardial infarction and/or receipt of coronary angiography and/or percutaneous coronary intervention on the day of admission. Temporal trends in in-hospital mortality were examined, and healthcare resource utilization was compared according to the presence or absence of CM. Results: Among 31,522 patients with surgically treated ATAAD, 1167 (3.7%) were classified as having CM. In-hospital mortality was substantially higher in patients with CM than in those without CM (34.3% vs 9.6%). After multivariable adjustment, CM was associated with increased in-hospital mortality after multivariable adjustment (adjusted hazard ratio, 1.80; 95% confidence interval, 1.58-2.06). Over the study period, in-hospital mortality declined significantly in patients without CM, whereas no temporal improvement was observed in those with CM. Patients with CM required substantially greater ICU-level resources, including prolonged mechanical ventilation and higher hospitalization costs. Conclusions: In this nationwide cohort of patients with surgically treated ATAAD, CM was associated with persistently poor short-term outcomes and greater ICU resource utilization, without clear improvement over time.