title: [Clinical profiles and surgical outcomes of coronary obstruction due to type A aortic dissection: a single institution experience].
abstract: OBJECTIVE
  To investigate the clinical profile of myocardial infarction (MI) due to retrograde aortic dissection of aortic root and the relevant predictors of in-hospital death.
  
  
  METHODS
  The clinical data of 207 consecutive patients with type A aortic dissection (AD), who were hospitalized and underwent operation between December 2003 and October 2007, were analyzed retrospectively.
  
  
  RESULTS
  Eight of the 207 patients were diagnosed as with MI due to retrograde aortic dissection of aortic root, 6 males and 2 females, aged (49 +/- 14). Surgical repair of the aorta and coronary revascularization was implanted: ascending aorta replacement in 2 cases, hemi-arch replacement in 5 cases, arch replacement in 1 case; coronary artery bypass grafting in 5 cases, and coronary repair in 3 cases. In-hospital death occurred in 4 of the 8 patients (50%) who all had preoperative renal insufficiency and developed acute renal failure (ARF) after surgery. Univariate analysis identified preoperative renal insufficiency an independent predictor of in-hospital death (The preoperative serum creatinine (sCr) level of the surviving patients was (80 +/- 30) micromol/L, significantly lower than that of the deceased patients [(176 +/- 67) micromol/L, P = 0.02]. There were no significant differences in other parameters between the surviving and deceased groups.
  
  
  CONCLUSIONS
  MI due to type A AD is associated with high operative mortality. Preoperative renal insufficiency attributes to development of ARF after surgery and the unfavorable outcome. Renal function before surgery is essential for risk stratification in this lethal condition.
authors.affiliation: Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Liu
authors.forename: Ju-ying
authors.initials: JY
authors.lastname: Qian
authors.forename: An-qing
authors.initials: AQ
authors.lastname: Chen
authors.forename: Tao
authors.initials: T
authors.lastname: Hong
authors.forename: Hao
authors.initials: H
authors.lastname: Chen
authors.forename: Dong
authors.initials: D
authors.lastname: Zhao
authors.forename: Wen-jun
authors.initials: WJ
authors.lastname: Ding
authors.forename: Qiang
authors.initials: Q
authors.lastname: Zhao
authors.forename: Chun-sheng
authors.initials: CS
authors.lastname: Wang
authors.forename: Jun-bo
authors.initials: JB
authors.lastname: Ge
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000401:mortality; D000328:Adult; D000784:Aortic Dissection / Q000401:mortality / Q000473:pathology*; D001011:Aorta / Q000473:pathology; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome