Abstract Background In patients diagnosed with acute type A aortic dissection (ATAAD), the NERI classification has been proposed to understand the type and extent of coronary artery involvement in determining the most appropriate surgical approach. Purpose To evaluate the impact of ATAAD with coronary artery involvement, classified according to the NERI system, on 30-day and long-term mortality rates. Methods We reviewed 600 ATAAD patients who underwent surgery and coronary computed tomography angiography from 2016 to 2020 at a hospital. Patients were classified based on the NERI classification system: Type A (ostial involvement), Type B (dissection in coronary body), and Type C (circumferential detachment or complete avulsion). The primary endpoint was 30-day mortality. Results Overall, 28.3% of the patients had coronary artery involvement, with NERI Types A, B, and C accounting for 13.3%, 11.1%, and 3.8%, respectively. The right coronary artery was more frequently involved (27.0%) than the left (10.3%). Compared to individuals without coronary artery involvement, those with coronary artery involvement exhibited a numerically higher 30-day mortality rate, albeit not statistically significant (5.3% vs. 2.3%; OR 2.35, 95%CI 0.94-5.88). After adjusting for potential confounders, coronary artery involvement was found to be significantly associated with an increased risk of 30-day mortality (adjusted OR 3.71, 95%CI 1.05-13.13). One-year mortality was higher in those with coronary artery involvement, but this significant association disappeared after adjusting for potential confounding variables. Furthermore, no significant difference in 30-day and one-year mortality were observed among patients with different NERI classifications (Figure 1). Conclusions In patients with ATAAD who undergo surgical procedures, the presence of coronary artery involvement is significantly associated with an increased risk of 30-day mortality. This finding highlights the importance of evaluating coronary artery involvement in ATAAD patients prior to surgical intervention and considering its potential impact on surgical outcomes.
Cui et al. (Sat,) studied this question.