Abstract 9404: Acute Coronary Syndrome-Like ST-T Changes on Admission Electrocardiogram Predicts 30-Day Mortality in Patients With Type A Acute Aortic Dissection
Introduction: In patients with Stanford type A acute aortic dissection (AAD), acute coronary syndrome (ACS)-like ST-T changes such as ST segment elevation (STE), depression (STD) or negative T wave (Neg T) often occur at presentation. However, its clinical implication remains unclear.
Methods: We studied the relation admission ECG findings to clinical features at presentation and 30-day mortality in 277 patients with type A AAD who were admitted within 12 h from symptom onset. Emergency surgery was performed in 251 patients (91%).
Results: Patients were divided into the 3 groups according to ECG findings on admission: ACS-like ST-T changes (n=140) [STE (n=14) and STD/Neg T (n=126)]; normal ECG (n=84), and ECG confounders (n=53) [right bundle branch block or left ventricular hypertrophy]. Age, sex, time to admission, and the rate of emergency surgery were similar in the 3 groups. ACS-like ST-T changes were more frequently associated with pericardial effusion (45% vs 10%, 32%), cardiac tamponade (27% vs 2%, 15%), moderate/severe aortic regurgitation (27% vs 7%, 19%), shock (34% vs 4%, 11%) on admission, and 30-day mortality (17% vs 2%, 8%) as compared with normal ECG and ECG confounders (all p<0.01). In 251 patients undergoing emergency surgery, those with ACS-like ST-T changes had higher rates of coronary ostial involvement (17% vs 1%, 2%), concomitant coronary artery bypass surgery (11% vs 1%, 0) as compared with those with normal ECG and those with ECG confounders (all p<0.01). On multivariate analysis, ACS-like ST-T changes (odds ratio 3.26, 95%CI 1.10 to 9.35, p=0.032) and no surgically treatment (odds ratio 5.60, 95%CI 2.27 to 24.6, p=0.011) were significant predictors of 30-day death. Patients who had ACS-like ST-T changes and no surgically treatment had strikingly higher 30-day mortality (Figure).
Conclusions: In patients with type A AAD, ACS-like ST-T changes on admission ECG were associated with more complicated features and independently predicted 30-day death.
Author Disclosures: M. Kosuge: None. K. Uchida: None. Y. Karube: None. T. Ebina: None. K. Hibi: None. M. Masuda: Research Grant; Significant; Edwards Science, Chugai. S. Umemura: Research Grant; Modest; Torii. Research Grant; Significant; Pfizer, Dainippon-Sumitomo, Astellas, Shionogi, Daiichi-Sankyo, MSD, Astrazeneca, Novartis, Nihon-Boehringer-Ingelheim. Honoraria; Modest; Shionogi, MSD, Kyowa-Hakko-Kirin. K. Kimura: Research Grant; Significant; Toa Eiyo Ltd, Bayer, MSD, Astellas, Astrazeneca, Sanofi, Eli Lilly Japan, Research Institute for Production Development, Otsuka, Novartis, Pfizer, Shionogi, Kowa-souyaku, Daiichi-Sankyo, Mitsubishi Tanabe, Nihon-Boehringer –Ingelheim, Takeda, Ono. Honoraria; Modest; Astrazeneca. Honoraria; Significant; MSD.
- © 2014 by American Heart Association, Inc.