Key result
Higher admission BP in aortic dissection is linked to ~61% lower in-hospital mortality.
Why the study?
The correlation between blood pressure level at admission and in-hospital case-fatality rate in patients with aortic dissection was unclear.
Does blood pressure level at admission correlate with in-hospital case-fatality rate in patients with aortic dissection?
Observational (n=580)
No
Does blood pressure level at admission correlate with in-hospital case-fatality rate in patients with aortic dissection?
Absolute Event Rate: 9.52% vs 24.3%
p-value: p=<0.01
In patients with aortic dissection, a higher blood pressure at admission is paradoxically associated with a lower in-hospital case-fatality rate, likely due to a higher proportion of Stanford type B dissections and prompt interventional therapy.
Admission hypotension was associated with higher in-hospital mortality in aortic dissection; leaves open whether BP thresholds modify outcomes in prospective trials.
Objective: To observe the correlation between the blood pressure level at admission in patients with aortic dissection and the in-hospital case-fatality rate. Methods: A retrospective analysis was carried out on the clinical data of 580 aortic dissection patients (198 cases of Stanford type A aortic dissection and 382 cases of Stanford type B aortic dissection) who were hospitalized in our hospital from 2011 to 2018. According to the level of blood pressure at admission, the patients were assigned into five groups: group A (90-119/60-79 mmHg, n=107), group B (120-139/80-90 mmHg, n=121), group C (140-159/90-99 mmHg, n=140), group D (160-179/100-109 mmHg, n=107) and group E (≥180 mmHg, n=105). The number of cases of different types of aortic dissections, treatment methods and number of deaths at discharge were recorded in each group. Results: No statistically significant differences in the sex, and histories of smoking, drinking, hypertension and diabetes were observed among the five groups (p>0.05). Group A exhibited higher proportions of patients with Stanford type A aortic dissection and Marfan syndrome, a younger mean age of patients, a lower heart rate of patients at admission and more cases of surgical treatment than the other groups (p<0.01). The proportions of cases of pain at admission, Stanford type B aortic dissection and interventional therapy in groups D and E were higher than those in the other groups (p<0.01). Of 580 inpatients, there were 87 (15%) cases of death, and the in-hospital case-fatality rate in group A was higher than that in the other groups (p<0.01). Group E had a lower in-hospital case-fatality rate than groups A, B, C and D (p<0.05), and the differences among the latter three groups were statistically significant (p<0.05). Therefore, the in-hospital case-fatality rate declined with the increase in the level of blood pressure at admission. Conclusion: A lower blood pressure level (<120/80 mmHg) and a higher blood pressure level (>160/100 mmHg) at admission in patients with aortic dissection can predict the classification of aortic dissection to a certain extent. The patients with a higher blood pressure level have obvious symptoms at admission and receive prompt treatments, and among them, more patients suffer from Stanford type B aortic dissection and undergo interventional therapy, so the overall case-fatality rate can be decreased.
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Gao et al. (2022) conducted an observational in Aortic Dissection (n=580). Blood pressure level at admission vs. Lower blood pressure levels (90-119/60-79 mmHg) was evaluated on In-hospital case-fatality rate (p=<0.01). Higher blood pressure at admission in patients with aortic dissection was associated with a lower in-hospital case-fatality rate, decreasing from 24.3% in patients with BP 90-119/60-79 mmHg to 9.52% in those with BP ≥180 mmHg.
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