title: Stroke and outcomes in patients with acute type A aortic dissection.
abstract: BACKGROUND
  Stroke is a highly dreaded complication of type A acute aortic dissection (TAAAD). However, little data exist on its incidence and association with prognosis.
  
  
  RESULTS
  We evaluated 2202 patients with TAAAD (mean age 62 ± 14 years, 1487 [67.5%] men) from the International Registry of Acute Aortic Dissection to determine the incidence and prognostic impact of stroke in TAAAD. Stroke was present at arrival in 132 (6.0%) patients with TAAAD. These patients were older (65 ± 12 versus 62 ± 15 years; P=0.002) and more likely to have hypertension (86% versus 71%; P=0.001) or atherosclerosis (29% versus 22%; P=0.04) than patients without stroke. Chest pain at arrival was less common in patients with stroke (70% versus 82%; P<0.001), and patients with stroke presented more often with syncope (44% versus 15%; P<0.001), shock (14% versus 7%; P=0.005), or pulse deficit (51% versus 29%; P ≤ 0.001). Arch vessel involvement was more frequent among patients with stroke (68% versus 37%; P<0.001). They had less surgical management (74% versus 85%; P<0.001). Hospital stay was significantly longer in patients with stroke (median 17.9 versus 13.3 days; P<0.001). In-hospital complications, such as hypotension, coma, and malperfusion syndromes, and in-hospital mortality (adjusted odds ratio, 1.62; 95% confidence interval, 0.99-2.65) were higher among patients with stroke. Among hospital survivors, follow-up mortality was similar between groups (adjusted hazard ratio, 1.15; 95% confidence interval, 0.46-2.89).
  
  
  CONCLUSIONS
  Stroke occurred in >1 of 20 patients with TAAAD and was associated with increased in-hospital morbidity but not long-term mortality. Whether aggressive early invasive interventions will reduce negative outcomes remains to be evaluated in future studies.
authors.affiliation: Department of Cardiology, University of Salerno, Salerno, Italy (E.B.); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI (D.C.C., E.K.-R., D.G.M., K.A.E.); Abbott-Northwestern Hospital, Minneapolis Heart Institute, Minneapolis, MN (K.M.H.); Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan (T.S.); Department of Interventional Cardiology, San Salvatore Hospital, Pesaro, Italy (R.F.); Department of Cardiac Sciences, University of Calgary, Calgary, Canada (S.H.); Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria (M.P.E.); Division of Medical Genetics, University of Pennsylvania, Philadelphia, PA (R.E.P.); Department of Cardiology, Hôpital Bichat, Paris, France (P.G.S.); Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN (K.G.); Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain (A.E.); Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA (E.M.I.); and Department of Internal Medicine, University of Rostock, Rostock, Germany (C.A.N.).
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
authors.forename: David C
authors.initials: DC
authors.lastname: Corteville
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Harris
authors.forename: Toru
authors.initials: T
authors.lastname: Suzuki
authors.forename: Rossella
authors.initials: R
authors.lastname: Fattori
authors.forename: Stuart
authors.initials: S
authors.lastname: Hutchison
authors.forename: Marek P
authors.initials: MP
authors.lastname: Ehrlich
authors.forename: Reed E
authors.initials: RE
authors.lastname: Pyeritz
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
authors.forename: Kevin
authors.initials: K
authors.lastname: Greason
authors.forename: Arturo
authors.initials: A
authors.lastname: Evangelista
authors.forename: Eva
authors.initials: E
authors.lastname: Kline-Rogers
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Montgomery
authors.forename: Eric M
authors.initials: EM
authors.lastname: Isselbacher
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000145:classification / Q000401:mortality* / Q000628:therapy; D001014:Aortic Aneurysm / Q000145:classification / Q000401:mortality* / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D016896:Treatment Outcome
keywords: aortic dissection; mortality; stroke management