title: Early risk factors in acute type A aortic dissection: is there a predictor of preoperative mortality?
abstract: BACKGROUND
  To describe the preoperative clinical, echocardiographic and biological findings in patients with acute aortic dissection and attempt to specify high risk factors of preoperative mortality.
  
  
  METHODS
  A retrospective, monocentric study of 148 patients admitted for acute type A aortic dissection. All patients underwent a clinical, echocardiographic and biological evaluation on admission. In 75 patients, we measured serum cardiac troponin I (cTnI).
  
  
  RESULTS
  In hospital mortality was 25.9% and 15.6% presented with preoperative cardiac circulatory arrest (POCCA). Patients with POCCA were more likely than others to have hypotension (97+/-56 vs 144+/-24 mmHg, p<0.01) or shock (52% vs 3%, p<0.01) on admission. Pericardial effusion (65% vs 35%, p=0.01) and tamponade (61% vs 8%, p<0.01) were also significantly linked to POCCA but not the aortic ascendant diameter. Detection of cTnI was more frequent in patients with POCCA (24% vs 7%, p=0.051) and was found to be a good predictor of in hospital mortality (47% vs 14%, p<0.01).
  
  
  CONCLUSIONS
  For patients with acute type A aortic dissection, hypotension or shock on admission, pericardial effusion or tamponade, as well as cTnI detection, were the main predictors for POCCA and imply immediate surgery.
authors.affiliation: Service de Cardiologie, Hôpital Militaire Desgenettes, 108 Boulevard Pinel, 69275 Lyon Cedex 03, France. patrick.godon@wanadoo.fr
authors.forename: P
authors.initials: P
authors.lastname: Godon
authors.forename: E
authors.initials: E
authors.lastname: Bonnefoy
authors.forename: G
authors.initials: G
authors.lastname: Desjeux
authors.forename: P
authors.initials: P
authors.lastname: Touboul
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality* / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality* / Q000601:surgery; D016009:Chi-Square Distribution; D004452:Echocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate