Shock complicating type A acute aortic dissection: Clinical correlates, management, and outcomes.
Shock is among the most dreaded and common complications of type A acute aortic dissection (TAAAD). However, clinical correlates, management, and short- and long-term outcomes of TAAAD patients presenting with shock in real-world clinical practice are not known.



We evaluated 2,704 patients with TAAAD enrolled in the International Registry of Acute Aortic Dissection between January 1, 1996, and August 18, 2012. On admission, 407 (15.1%) TAAAD patients presented with shock. Most in-hospital complications (coma, myocardial or mesenteric ischemia or infarction, and cardiac tamponade) were more frequent in shock patients. In-hospital mortality was significantly higher in TAAAD patients with than without shock (30.2% vs 23.9%, P=.007), regardless of surgical or medical treatment. Most shock patients underwent surgical repair, with medically managed patients demonstrating older age and more complications at presentation. Estimates using Kaplan-Meier survival analysis indicated that most (89%) TAAAD patients with shock discharged alive from the hospital survived 5years, a rate similar to that of TAAAD patients without shock (82%, P=.609).



Shock occurred in 1 of 7 TAAAD patients and was associated with higher rates of in-hospital adverse events and mortality. However, TAAAD survivors with or without shock showed similar long-term mortality. Successful early and aggressive management of shock in TAAAD patients has the potential for improving long-term survival in this patient population.
Cardiology Division, University of Salerno, Salerno, Italy. Electronic address: ebossone@hotmail.com.
Eduardo
E
Bossone
Departments of Medicine and Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Reed E
RE
Pyeritz
Cardiovascular Division, Washington University, St Louis, MO.
Alan C
AC
Braverman
Division of Cardiac Surgery, St Michael's Hospital, Toronto, Ontario, Canada.
Mark D
MD
Peterson
Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria.
Marek
M
Ehrlich
Department of Cardiology, Brigham & Women's Hospital, Boston, MA.
Patrick
P
O'Gara
Cardiovascular Medicine, University of Tokyo, Tokyo, Japan.
Toru
T
Suzuki
Thoracic Aortic Research Center, IRCCS Policlinico San Donato, San Donato, Italy.
Santi
S
Trimarchi
Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Dan
D
Gilon
Cardiovascular Surgery Department, Mayo Clinic, Rochester, MN.
Kevin
K
Greason
Department of Cardiovascular Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Nimesh D
ND
Desai
Cardiovascular Center, University of Michigan, Ann Arbor, MI.
Daniel G
DG
Montgomery
Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA.
Eric M
EM
Isselbacher
Department of Internal Medicine, University of Rostock, Rostock, Germany.
Christoph A
CA
Nienaber
Cardiovascular Center, University of Michigan, Ann Arbor, MI.
Kim A
KA
Eagle
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000453:epidemiology; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000453:epidemiology; D019468:Disease Management; D005260:Female; D014943:Global Health / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D012042:Registries; D012307:Risk Factors; D012769:Shock / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D014656:Vascular Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data