title: Pulse pressure and type A acute aortic dissection in-hospital outcomes (from the International Registry of Acute Aortic Dissection).
abstract: Little is known about the relation between type A acute aortic dissection (TAAAD) and pulse pressure (PP), defined as the difference between systolic and diastolic blood pressure. In this study, we explored the association between PP and presentation, complications, and outcomes of patients with TAAAD. PP at hospital presentation was used to divide 1,960 patients with noniatrogenic TAAAD into quartiles: narrowed (≤39 mm Hg, n=430), normal (40 to 56 mm Hg, n=554), mildly elevated (57 to 75 mm Hg, n=490), and markedly elevated (≥76 mm Hg, n=486). Variables relating to index presentation and in-hospital outcomes were analyzed. Patients with TAAAD in the narrowed PP quartiles were frequently older and Caucasian, whereas patients with markedly elevated PPs tended to be male and have a history of hypertension. Patients who demonstrated abdominal vessel involvement more commonly demonstrated elevated PPs, whereas patients with narrowed PPs were more likely to have periaortic hematoma and/or pericardial effusion. Narrowed PPs were also correlated with greater incidences of hypotension, cardiac tamponade, and mortality. Patients with TAAAD who were managed with endovascular and hybrid procedures and those with renal failure tended to have markedly elevated PPs. No difference in aortic regurgitation at presentation was noted among groups. In conclusion, patients with TAAAD in the third PP quartile had better in-hospital outcomes than patients in the lowest quartile. Patients with narrowed PPs experienced more cardiac complications, particularly cardiac tamponade, whereas those with markedly elevated PPs were more likely to have abdominal aortic involvement. Presenting PP offers a clue to different manifestations of acute aortic dissection that may facilitate initial triage and care.
authors: Cardiovascular Center, University of Michigan, Ann Arbor, Michigan.
authors: Emily
authors: E
authors: Hoff
authors: Cardiovascular Center, University of Michigan, Ann Arbor, Michigan.
authors: Taylor
authors: T
authors: Eagle
authors: Division of Medical Genetics, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Reed E
authors: RE
authors: Pyeritz
authors: Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria.
authors: Marek
authors: M
authors: Ehrlich
authors: Department of Cardiology and Pulmonology, Robert-Bosch Krankenhaus, Stuttgart, Germany.
authors: Matthias
authors: M
authors: Voehringer
authors: Cardiology Division, University of Salerno, Salerno, Italy.
authors: Eduardo
authors: E
authors: Bossone
authors: Departments of Cardiac Sciences, Medicine and Radiology, University of Calgary, Calgary, Alberta, Canada.
authors: Stuart
authors: S
authors: Hutchison
authors: Division of Cardiac Surgery, St. Michael's Hospital, Toronto, Ontario, Canada.
authors: Mark D
authors: MD
authors: Peterson
authors: Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan.
authors: Toru
authors: T
authors: Suzuki
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors: Kevin
authors: K
authors: Greason
authors: Department of Cardiac Surgery, Hospital Universitario "12 de Octubre", Madrid, Spain.
authors: Alberto
authors: A
authors: Forteza
authors: Cardiovascular Center, University of Michigan, Ann Arbor, Michigan.
authors: Daniel G
authors: DG
authors: Montgomery
authors: Thoracic Aortic Center, Massachusetts General Hospital, Boston, Massachusetts.
authors: Eric M
authors: EM
authors: Isselbacher
authors: Department of Internal Medicine, University of Rostock, Rostock, Germany.
authors: Christoph A
authors: CA
authors: Nienaber
authors: Cardiovascular Center, University of Michigan, Ann Arbor, Michigan. Electronic address: elisew@umich.edu.
authors: Kim A
authors: KA
authors: Eagle
mesh_terms: D000208:Acute Disease; D000784:Aortic Dissection / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology*; D002305:Cardiac Tamponade / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies