Abstract 9387: Painless Acute Aortic Dissection is Associated with Poor Functional Outcome: Relationship to Clinical Characteristics and Diagnostic Procedure
Background: Prompt diagnosis of acute aortic dissection (AAD) is essential for successful management. AAD classically presents with severe chest, back, or abdominal pain. However, there have been several documented cases presenting with atypical features. Making diagnosis is difficult when the classic pattern of pain is absent. Hypothesis: The purpose of this study was to investigate the clinical characteristics of patients with painless AAD and to assess the hypothesis that the diagnostic delay in painless AAD might cause poor prognosis.
Methods: One hundred and twenty-four patients with AAD were admitted our hospital from 2002 to 2007. After excluding patients with an out-of-hospital cardiac arrest, 98 patients (53 males, 45 females; 66±12 years) were studied. Sixteen patients (17%) had no pain (Painless group) and 82 patients had pain (Painful group). Eighty-one per cent and 70% of patients had a type A dissection, respectively.
Results: The time from admission to a definite diagnosis was longer in the Painless group (P=0.004). The diagnosis was made within 1 hour of admission in 40% of patients in the Painless group and in 76% in the Painful group. The Painless group more frequently had a persistent disturbance of consciousness (44% vs 6%, P<0.001); syncope (25% vs 1%, P<0.001); and a focal neurologic deficit (19% vs 2%, P=0.006) as presenting symptoms. Cerebral ischemia (50% vs 1%, P<0.001) and cardiac tamponade (38% vs 13%, P=0.01) were more frequent complications in the Painless group. In-hospital mortality was not significantly different (19% vs 15%). However, the Painless group had a more unfavorable functional outcome on Overall Performance Category (P<0.001). Characteristics associated with unfavorable functional outcome were cerebral ischemia and cardiac tamponade on admission. The time from admission to a definite diagnosis was not significantly related with unfavorable functional outcome.
Conclusions: Painless AAD patients often present with a disturbance of consciousness or a neurologic deficit and have higher morbidity. Although it takes more time for definite diagnosis of painless AAD than painful AAD, the major causes for increased morbidity are complications of AAD on admission rather than the diagnostic delay.
- © 2012 by American Heart Association, Inc.