Abstract 9307: Acute Coronary Syndrome-Like ST-T Changes on Admission Electrocardiogram Predicts In-hospital Death in Patients With Type A Acute Aortic Dissection
Background: In patients with Stanford type A acute aortic dissection (AAD), acute coronary syndrome (ACS)-like ST-T changes such as ST segment elevation (STE) or depression (STD) or negative T wave (Neg T) have been shown to be often observed at presentation. However, the frequency and prognostic impact of such ECG findings remain unclear.
Methods: We studied the relation admission ECG findings to clinical features at presentation and in-hospital mortality in 258 patients with type A AAD who were admitted within 6 h from symptom onset. Emergency surgery was underwent in 233 patients (90%).
Results: Patients were divided into the 3 groups according to ECG findings on admission: ACS-like ST-T changes (n=131) [STE (n=11) and STD/Neg T (n=120)]; normal ECG (n=77), and ECG confounders (n=50) [right bundle branch block (n=20) and left ventricular hypertrophy (n=30)]. Age, sex, time to admission, the rate of emergency surgery were similar in the 3 groups. Patients with ACS-like ST-T changes had more frequently had positive troponin (17% vs 3%, 13%), severe hypertension as defined by systolic blood pressure ≥180 mmHg (18% vs 5%, 6%), pericardial effusion (46% vs 9%, 34%), cardiac tamponade (27% vs 3%, 18%), moderate/severe aortic regurgitation (27% vs 7%, 18%), shock (33% vs 3%, 12%) on admission, and in-hospital mortality (14% vs 3%, 6%) as compared with patients who had normal ECG and those who had ECG confounders (p<0.05 for all). In 233 patients undergoing emergency surgery, those with ACS-like ST-T changes had higher prevalences of coronary ostial involvement (14% vs 1%, 2%), concomitant coronary artery bypass surgery (9% vs 1%, 0%) as compared with those with normal ECG and those with ECG confounders (all p<0.05, respectively). On multivariate analysis, ACS-like ST-T changes (odds ratio 3.28, 95%CI 1.02 to 10.1, p=0.038) and no surgically treatment (odds ratio 4.37, 95%CI 1.29 to 14.9, p=0.018) were the independent and significant predictors of in-hospital death.
Conclusions: Nearly 50% of patients with type A AAD within 6 h from symptom onset showed ACS-like ST-T changes on admission ECG, especially STD/Neg T. ACS-like ST-T changes were associated with more complicated features and independently predicted in-hospital death.
- © 2013 by American Heart Association, Inc.