title: The role of preoperative coronary angiography in the setting of type A acute aortic dissection: insights from the International Registry of Acute Aortic Dissection.
abstract: BACKGROUND
  Performing preoperative coronary angiography (CA) before surgical repair of a type A acute aortic dissection (TA-AAD) remains controversial. Although the information provided by CA may be useful in planning the surgical approach, the potential delay to surgery and complications of CA may confer added risk of death before definitive repair of the aorta.
  
  
  METHODS
  We analyzed 1,343 patients from January 27, 1996, to May 3, 2010, with TA-AAD from the International Registry of Acute Aortic Dissection who underwent surgical or endovascular repair during the index hospitalization, with (n = 156) or without (n = 1,187) preoperative CA. The main outcomes measured were in-hospital complications and in-hospital and long-term mortality.
  
  
  RESULTS
  Patients who underwent preoperative CA were more likely to have a history of atherosclerosis and present with electrocardiographic signs of myocardial ischemia/infarction. In the preoperative CA group, significant delays from the onset of symptoms to the time of surgery occurred. In-hospital postoperative complications and mortality rates were largely similar between the 2 groups. On multivariable logistic regression analysis, preoperative CA had no significant effect on in-hospital risk-adjusted mortality when compared to the validated International Registry of Acute Aortic Dissection risk score. Long-term mortality was similar between patients receiving preoperative CA and those who did not; long-term rehospitalization rates were higher, although largely insignificantly, among preoperative CA recipients through 5 years of follow-up.
  
  
  CONCLUSIONS
  Preoperative CA is infrequently performed on patients with TA-AAD, except, occasionally, on patients at high risk for myocardial ischemia. When performed, preoperative CA was not associated with any significant changes in in-hospital and long-term mortality.
authors.affiliation: Heart and Vascular Center, Dartmouth Medical School, Lebanon, NH, USA. vijaysr1977@gmail.com
authors.forename: Vijay S
authors.initials: VS
authors.lastname: Ramanath
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
authors.forename: Eric M
authors.initials: EM
authors.lastname: Isselbacher
authors.forename: James B
authors.initials: JB
authors.lastname: Froehlich
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Montgomery
authors.forename: Jeanna V
authors.initials: JV
authors.lastname: Cooper
authors.forename: Xiaokui
authors.initials: X
authors.lastname: Gu
authors.forename: Arturo
authors.initials: A
authors.lastname: Evangelista
authors.forename: Matthias
authors.initials: M
authors.lastname: Voehringer
authors.forename: Joshua
authors.initials: J
authors.lastname: Beckman
authors.forename: Truls
authors.initials: T
authors.lastname: Myrmel
authors.forename: Linda
authors.initials: L
authors.lastname: Pape
authors.forename: Reed E
authors.initials: RE
authors.lastname: Pyeritz
authors.forename: Alan T
authors.initials: AT
authors.lastname: Hirsch
authors.forename: Dan
authors.initials: D
authors.lastname: Gilon
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality*; D017023:Coronary Angiography / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors