Key result
Presenting with a cerebrovascular accident in patients ≥70 years with type A acute aortic dissection was independently associated with increased in-hospital mortality (OR 2.99; 95% CI 1.35-6.60; P=0.007).
Why the study?
Outcomes of patients aged 70 years or above presenting with type A acute aortic dissection and cerebrovascular accident needed to be analyzed.
Does the presence of CVA before surgery affect in-hospital and long-term mortality in patients aged ≥70 years presenting with type A acute aortic dissection?
Cohort (n=1,449)
Yes
Does the presence of CVA before surgery affect in-hospital and long-term mortality in patients aged ≥70 years presenting with type A acute aortic dissection?
Odds Ratio: 2.99 (95% CI 1.35–6.6)
Absolute Event Rate: 32.7% vs 21.7%
p-value: p=0.007
In patients ≥70 years with type A acute aortic dissection, presenting with a CVA significantly increases in-hospital mortality but does not affect long-term survival among those who survive to discharge.
CVA on presentation signals elevated in-hospital mortality risk in elderly type A aortic dissection; leaves open optimal management to improve survival.
Our aim was to analyze outcomes of patients aged 70 years or above presenting with type A acute aortic dissection (TAAAD) and cerebrovascular accident (CVA). A retrospective analysis of the International Registry of Acute Aortic Dissection (IRAD) was conducted. Patients aged 70 years or above (n = 1449) were stratified according to presence or absence of CVA before surgery (CVA: n = 110, 7.6%). In-hospital outcomes and mortality up to 5 years were analyzed. Additionally, in-hospital outcomes of patients who received medical management were described. No patient presenting with CVA over the age of 87 years underwent surgery. The rates of in-hospital mortality and post-operative CVA were significantly higher in patients presenting with CVA (in-hospital mortality: 32.7% vs 21.7%, P = 0.008; post-operative CVA: 23.4% vs 8.3%, P < 0.001). Presence of CVA was independently associated with significantly increased in-hospital mortality (odds ratio 2.99, 95% confidence interval 1.35 - 6.60, P = 0.007). In survivors of the hospital stay, presenting CVA had no independent influence on mortality up to 5 years (hazard ratio 1.52, 95% confidence interval 0.99 - 2.31, P = 0.54). In medically managed patients, exceedingly high rates of in-hospital mortality (71.4%) and CVA (90.9%) were noted. Patients presenting with TAAAD and CVA at ≥ 70 years of age are at significantly increased risk of in-hospital mortality, although long-term mortality is not affected in hospital survivors. Medical management is associated with poor outcomes. We believe that surgical management should be offered after critical assessment of comorbidities.
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Angleitner et al. (2021) conducted a cohort in Type A acute aortic dissection (TAAAD) (n=1,449). Cerebrovascular accident (CVA) before surgery vs. Absence of CVA before surgery was evaluated on In-hospital mortality (OR 2.99, 95% CI 1.35 - 6.60, p=0.007). Presenting with a cerebrovascular accident in patients ≥70 years with type A acute aortic dissection was independently associated with increased in-hospital mortality (OR 2.99; 95% CI 1.35-6.60; P=0.007).
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