Prognostic impact of shock in patients with type A acute aortic syndrome. Results of a nationwide multicenter study.

Autor:	Ferrera C; Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain. Electronic address: carlosferreraduran@gmail.com., Vilacosta I; Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain., Rodríguez Palomares JF; Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain., Calvo Iglesias F; Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain., Barros-Membrilla AJ; Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain., Azqueta Molluna M; Servicio de Cardiología, Hospital Clínic, Barcelona, Spain., Mosquera V; Servicio de Cirugía Cardiaca, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain., Tarrío R; Servicio de Cirugía Cardiaca, Hospital Son Espases, Palma de Mallorca, Spain., Revilla Orodea A; Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain., Toral Sepúlveda D; Servicio de Cirugía Cardiaca, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain., Ramos González-Cristóbal I; Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain., Maroto Castellanos L; Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain., Sao A; Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain., Evangelista A; Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Jazyk:	angličtina
Zdroj:	Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese [Hellenic J Cardiol] 2024 May 09. Date of Electronic Publication: 2024 May 09.
DOI:	10.1016/j.hjc.2024.05.005
Abstrakt:	Objective: To evaluate the clinical characteristics, imaging findings, treatment, and prognosis of patients with type A acute aortic syndrome (AAS-A) presenting with shock. To assess the impact of surgery on this patient population. Methods: The study included 521 patients with A-AAS enrolled in the Spanish Registry of Acute Aortic Syndrome (RESA-III) from January 2018 to December 2019. The RESA-III is a prospective, multicenter registry that contains AAS data from 30 tertiary-care hospitals. Patients were classified into two groups according to their clinical presentation, with or without shock. Shock was defined as persistent systolic blood pressure <80 mmHg despite adequate volume resuscitation. Results: 97 (18.6%) patients with A-AAS presented with shock. Clinical presentation with syncope was much more common in the Shock group (45.4% vs 10.1%, p = 0.001). Patients in the Shock group had more complications at diagnosis and before surgery: cardiac tamponade (36.2% vs 9%, p < 0.001), acute renal failure (28.9% vs 18.2%, p = 0.018), and need for orotracheal intubation (40% vs 9.1%, p < 0.001). There were no significant differences in aortic regurgitation (51.6% vs 46.7%, p = 0.396) between groups. In-hospital mortality was higher among patients with shock (48.5% vs 27.4%, p < 0.001). Surgery was associated with a significant mortality reduction both in patients with and without shock. Surgery had an independent protective effect on mortality (OR 0.03, 95% CI (0.00-0.32)). Conclusion: Patients with AAS-A admitted with shock have a heavily increased risk of mortality. Syncope and pericardial effusion at diagnosis are strongly associated with shock. Surgery was independently associated with a mortality reduction in patients with AAS-A and shock. Competing Interests: Conflict of interest statement There are no potential conflicts of interest to declare. (Copyright © 2024 Hellenic Society of Cardiology. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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