Factors associated with in-hospital mortality in patients with acute aortic syndrome involving the ascending aorta.
BACKGROUND
Aortic intramural hematoma (IMH), a variant form of classic dissection (AD), is an increasingly recognized and potentially fatal entity of acute aortic syndrome (AAS). We sought to assess the real impact of increased recognition of IMH on mortality of AAS involving the ascending aorta.


METHODS
We evaluated 186 consecutive patients with AAS involving the ascending aorta (57.0+/-13.5 years, 95 females) admitted between January 1993 and March 2003.


RESULTS
Final diagnosis was AD in 135 patients and IMH in 51 (27%). Patients with AD were younger (54.0+/-13 vs. 65.6+/-10.7 years, p<0.05) and surgery was more frequently performed (82% vs. 31%, p<0.001). Overall in-hospital mortality was 16% (30/186); both total mortality (19% vs. 8%, p=0.059) and mortality without surgery (71% vs. 9%, p<0.001) was higher in AD. Logistic regression identified the following presenting variables as predictors of mortality: AD (OR 53.0; 95% CI, 6.6-425.4; p<0.001), confusion/coma (OR 20.1; 95% CI, 3.8-107.8; p<0.001), tamponade (OR 5.3; 95% CI, 1.2-24.3; p=0.031), heart failure (OR 8.1; 95% CI, 1.1-61.0; p=0.043), and medical treatment only (OR 17.6; 95% CI, 4.6-67.6, p<0.001). Tamponade was more prevalent in IMH (25% vs. 11%, p=0.038), and was a predictor of higher mortality in both groups.


CONCLUSIONS
IMH comprises of significant proportion of AAS involving the ascending aorta and is an independent variable associated with lower mortality despite lower frequency of surgery. Treatment option including optimal timing of surgery can be individualized based on underlying disease entity of AAS and some clinical features at the initial presentation.
Song
Jae-Kwan
JK
Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong Songpa-ku, Seoul, 138-736, South Korea. jksong@amc.seoul.kr
Kang
Soo-Jin
SJ
Song
Jong-Min
JM
Kang
Duk-Hyun
DH
Song
Hyun
H
Chung
Cheol Hyun
CH
Lee
Jae Won
JW
Song
Meong Gun
MG
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality*; D001011:Aorta; D001014:Aortic Aneurysm / Q000401:mortality*; D005260:Female; D006406:Hematoma / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors