Abstract 20296: In-Hospital Outcomes for Type A Acute Aortic Dissection Patients Presenting With Abnormal Admission Electrocardiogram
Introduction: Electrocardiogram (ECG) is often used to assist in the diagnosis of patients presenting with chest pain to emergency departments. Given that this type of pain is a common manifestation of Type A Acute Aortic Dissection (TAAAD), ECGs are obtained in much of this population. This study evaluated the impact of particular ECG patterns on the diagnosis and treatment of TAAAD.
Methods: TAAAD patients (N=2765) enrolled in the International Registry of Acute Aortic Dissection were stratified into groups based on normal (N=1094, 39.6%) and abnormal (N=1671, 60.4%) presenting ECGs, and further subdivided according to specific ECG findings. Time data is presented in hours as medians (Q1-Q3).
Results: Patients with abnormal ECG findings presented to the hospital sooner after symptom onset than those with normal ECGs (1.4 (0.8-3.3) v 2.0 (1.0-3.3); p=0.005). Specifically, shorter time from symptom onset to presentation was seen in patients with infarction with new Qs or ST elevation (1.3 (0.6-2.7) v 1.5 (0.8-3.3); p=0.049). Abnormal ECG findings were associated with less frequent surgical management (84.7% v 92.8%; p<0.001). Additionally, the time between symptom onset and intervention was longer with infarction with old Qs (12.8 (6.3-43.0) v 9.3 (6.0-20.5); p=0.041) or non-specific ST-T changes (10.5 (6.6-22.1) v 8.5 (5.6-20.6); p=0.002). Surgical mortality was higher in patients with abnormal ECG findings (20.6% v 11.9%, p<0.001), especially in those with ischemia (25.7% v 16.8%, p<0.001) and infarction with new Q waves or ST elevation (30.1% v 17.1%, p<0.001).
Conclusions: An abnormal ECG in patients with TAAAD remains an adverse prognosticator identifying a group of patients who are sicker, have more in-hospital complications, and are more likely to die. That nonspecific ST-T abnormalities are seen in more than 40% of TAAAD patients are associated with a delay in diagnosis and treatment suggests that this is an area for further study.
Author Disclosures: N. Costin: None. A. Korach: None. G. Loor: None. M.D. Peterson: None. N.D. Desai: None. S. Trimarchi: None. T. Ota: None. T.B. Reece: None. T.M. Sundt: None. H.J. Patel: None. E.P. Chen: None. D.G. Montgomery: None. C.A. Nienaber: None. E.M. Isselbacher: None. K.A. Eagle: Research Grant; Modest; Medtronic, Terumo. Research Grant; Significant; W.L. Gore & Associates. T.G. Gleason: Other; Significant; National Steering Committee - Medtronic CoreValve trials.
- © 2016 by American Heart Association, Inc.