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Stroke in acute type A aortic dissection : the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD)

Chemtob, Raphaelle A. ; Fuglsang, Simon ; Geirsson, Arnar ; Ahlsson, Anders ; Olsson, Christian ; Gunn, Jarmo ; Ahmad, Khalil ; Hansson, Emma C. LU ; Pan, Emily and Arnadottir, Linda O. , et al. (2020) In European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 58(5). p.1027-1034
Abstract

OBJECTIVES: Stroke is a serious complication in patients with acute type A aortic dissection (ATAAD). Previous studies investigating stroke in ATAAD patients have been limited by small cohorts and have shown diverging results. We sought to identify risk factors for stroke and to evaluate the effect of stroke on outcomes in surgical ATAAD patients. METHODS: The Nordic Consortium for Acute Type A Aortic Dissection database included patients operated for ATAAD at 8 Scandinavian Hospitals between 2005 and 2014. RESULTS: Stroke occurred in 177 (15.7%) out of 1128 patients. Patients with stroke presented more frequently with cerebral malperfusion (20.6% vs 6.3%, P < 0.001), syncope (30.6% vs 17.6%, P < 0.001), cardiogenic shock (33.1%... (More)

OBJECTIVES: Stroke is a serious complication in patients with acute type A aortic dissection (ATAAD). Previous studies investigating stroke in ATAAD patients have been limited by small cohorts and have shown diverging results. We sought to identify risk factors for stroke and to evaluate the effect of stroke on outcomes in surgical ATAAD patients. METHODS: The Nordic Consortium for Acute Type A Aortic Dissection database included patients operated for ATAAD at 8 Scandinavian Hospitals between 2005 and 2014. RESULTS: Stroke occurred in 177 (15.7%) out of 1128 patients. Patients with stroke presented more frequently with cerebral malperfusion (20.6% vs 6.3%, P < 0.001), syncope (30.6% vs 17.6%, P < 0.001), cardiogenic shock (33.1% vs 20.7%, P < 0.001) and pericardial tamponade (25.9% vs 14.7%, P < 0.001) and more often underwent total aortic arch replacement (10.7% vs 4.7%, P = 0.016), compared to patients without stroke. In the 86 patients presenting with cerebral malperfusion, 38.4% developed stroke. Thirty-day and 5-year mortality in patients with and without stroke were 27.1% vs 13.6% and 42.9% vs 25.6%, respectively. Stroke was an independent predictor of early- [odds ratio 2.02, 95% confidence interval (CI) 1.34-3.05; P < 0.001] and midterm mortality (hazard ratio 1.68, 95% CI 1.27-2.23; P < 0.001). CONCLUSIONS: Stroke in ATAAD patients is associated with increased early- and midterm mortality. Preoperative cerebral malperfusion and impaired haemodynamics, as well as total aortic arch replacement, were more frequent among patients who developed stroke. Importantly, a large proportion of patients presenting with cerebral malperfusion did not develop a permanent stroke, indicating that signs of cerebral malperfusion should not be considered a contraindication for surgery.

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type
Contribution to journal
publication status
published
subject
keywords
Acute type A aortic dissection, Cardiac surgery, Cerebral malperfusion, Stroke
in
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
volume
58
issue
5
pages
8 pages
publisher
Oxford University Press
external identifiers
  • scopus:85094221851
  • pmid:32688394
ISSN
1010-7940
DOI
10.1093/ejcts/ezaa197
language
English
LU publication?
yes
id
dafea990-0ec0-473c-89a7-1ea57bb08a18
date added to LUP
2020-11-05 14:17:31
date last changed
2024-04-17 18:40:34
@article{dafea990-0ec0-473c-89a7-1ea57bb08a18,
  abstract     = {{<p>OBJECTIVES: Stroke is a serious complication in patients with acute type A aortic dissection (ATAAD). Previous studies investigating stroke in ATAAD patients have been limited by small cohorts and have shown diverging results. We sought to identify risk factors for stroke and to evaluate the effect of stroke on outcomes in surgical ATAAD patients. METHODS: The Nordic Consortium for Acute Type A Aortic Dissection database included patients operated for ATAAD at 8 Scandinavian Hospitals between 2005 and 2014. RESULTS: Stroke occurred in 177 (15.7%) out of 1128 patients. Patients with stroke presented more frequently with cerebral malperfusion (20.6% vs 6.3%, P &lt; 0.001), syncope (30.6% vs 17.6%, P &lt; 0.001), cardiogenic shock (33.1% vs 20.7%, P &lt; 0.001) and pericardial tamponade (25.9% vs 14.7%, P &lt; 0.001) and more often underwent total aortic arch replacement (10.7% vs 4.7%, P = 0.016), compared to patients without stroke. In the 86 patients presenting with cerebral malperfusion, 38.4% developed stroke. Thirty-day and 5-year mortality in patients with and without stroke were 27.1% vs 13.6% and 42.9% vs 25.6%, respectively. Stroke was an independent predictor of early- [odds ratio 2.02, 95% confidence interval (CI) 1.34-3.05; P &lt; 0.001] and midterm mortality (hazard ratio 1.68, 95% CI 1.27-2.23; P &lt; 0.001). CONCLUSIONS: Stroke in ATAAD patients is associated with increased early- and midterm mortality. Preoperative cerebral malperfusion and impaired haemodynamics, as well as total aortic arch replacement, were more frequent among patients who developed stroke. Importantly, a large proportion of patients presenting with cerebral malperfusion did not develop a permanent stroke, indicating that signs of cerebral malperfusion should not be considered a contraindication for surgery.</p>}},
  author       = {{Chemtob, Raphaelle A. and Fuglsang, Simon and Geirsson, Arnar and Ahlsson, Anders and Olsson, Christian and Gunn, Jarmo and Ahmad, Khalil and Hansson, Emma C. and Pan, Emily and Arnadottir, Linda O. and Mennander, Ari and Nozohoor, Shahab and Wickbom, Anders and Zindovic, Igor and Pivodic, Aldina and Jeppsson, Anders and Hjortdal, Vibeke and Gudbjartsson, Tomas}},
  issn         = {{1010-7940}},
  keywords     = {{Acute type A aortic dissection; Cardiac surgery; Cerebral malperfusion; Stroke}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{1027--1034}},
  publisher    = {{Oxford University Press}},
  series       = {{European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery}},
  title        = {{Stroke in acute type A aortic dissection : the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD)}},
  url          = {{http://dx.doi.org/10.1093/ejcts/ezaa197}},
  doi          = {{10.1093/ejcts/ezaa197}},
  volume       = {{58}},
  year         = {{2020}},
}