title: Postoperative myocardial infarction in acute type A aortic dissection: A report from the International Registry of Acute Aortic Dissection.
abstract: Postoperative myocardial infarction remains a serious complication in cardiac surgery. The incidence and impact of this condition in acute type A aortic dissection are poorly understood.
  
  
  
  A total of 1445 patients with acute type A aortic dissection who underwent surgery were enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2013. Individuals with preoperative myocardial infarction at hospital presentation and a history of myocardial infarction were excluded. Patients with postoperative myocardial infarction (n = 38, 2.6%) were compared with those without postoperative myocardial infarction (n = 1407, 97.4%).
  
  
  
  The postoperative myocardial infarction group was more often of white race (100% vs 90%, P = .043) with bicuspid aortic valve (15.6% vs 4.5%, P = .015). Imaging demonstrated more aortic root involvement (75.8% vs 49.5%, P = .003), pericardial effusion (65.5% vs 44.1%, P = .022), and coronary artery compromise (27.3% vs 10.2%, P = .022). Patients with postoperative myocardial infarction were more frequently hypotensive or in shock during surgery (42.9% vs 25.5%, P = .021). Patients with postoperative myocardial infarction were more likely to have undergone root replacement (54.5% vs 33.3%, P = .011), coronary artery bypass grafting (28.6% vs 7.4%, P < .001), or aortic valve replacement (40.0% vs 23.8%, P = .027), and less likely to have had complete arch replacement (2.8% vs 14.0%, P = .050). Median circulatory arrest time was higher in postoperative myocardial infarction (60 vs 38 minutes, P = .024). In-hospital mortality (57.9% vs 16.3%, P < .001) and Kaplan-Meier estimates of 5-year mortality (P = .007) were distinctly higher in postoperative myocardial infarction.
  
  
  
  Postoperative myocardial infarction is a devastating complication of type A aortic dissection repair. It is associated with bicuspid aortic valve, root involvement, pericardial effusion, and extent of surgical repair. Patients with postoperative myocardial infarction have higher serious postoperative complications, in-hospital mortality, and 5-year mortality rates than those without postoperative myocardial infarction.
authors.affiliation: Division of Cardiothoracic Surgery, Cedars Sinai Medical Center, Los Angeles, Calif.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Waterford
authors.affiliation: Department of Cardiac Surgery, University of Bologna, Bologna, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Di Eusanio
authors.affiliation: Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria.
authors.forename: Marek P
authors.initials: MP
authors.lastname: Ehrlich
authors.affiliation: Division of Cardiothoracic Surgery, University of Colorado, Aurora, Colo.
authors.forename: T Brett
authors.initials: TB
authors.lastname: Reece
authors.affiliation: Division of Cardiothoracic Surgery, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Nimesh D
authors.initials: ND
authors.lastname: Desai
authors.affiliation: Division of Cardiothoracic Surgery, Massachusetts General Hospital, Boston, Mass.
authors.forename: Thoralf M
authors.initials: TM
authors.lastname: Sundt
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University of Tromsoe, Tromsoe, Norway.
authors.forename: Truls
authors.initials: T
authors.lastname: Myrmel
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Gleason
authors.affiliation: Cardiac Surgery Department, Hospital Quiron Madrid, Madrid, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Forteza
authors.affiliation: Department of Cardiac Surgery, Policlinico San Donato, San Donato Milanese, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: de Vincentiis
authors.affiliation: Division of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: DiScipio
authors.affiliation: Cardiovascular Division, University of Michigan, Ann Arbor, Mich.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Montgomery
authors.affiliation: Cardiovascular Division, University of Michigan, Ann Arbor, Mich.
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Boston, Mass.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Isselbacher
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Muehle
authors.affiliation: Division of Cardiothoracic Surgery, Cedars Sinai Medical Center, Los Angeles, Calif.
authors.forename: Aamir
authors.initials: A
authors.lastname: Shah
authors.affiliation: Division of Cardiothoracic Surgery, Cedars Sinai Medical Center, Los Angeles, Calif.
authors.forename: Daisy
authors.initials: D
authors.lastname: Chou
authors.affiliation: Cardiology and Aortic Center, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
authors.affiliation: Division of Cardiothoracic Surgery, Cedars Sinai Medical Center, Los Angeles, Calif. Electronic address: Akhoy@cshs.org.
authors.forename: Ali
authors.initials: A
authors.lastname: Khoynezhad
mesh_terms: D000208:Acute Disease; D000784:Aortic Dissection / Q000175:diagnosis / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography; D004562:Electrocardiography; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
keywords: aortic dissection; myocardial infarction; type A dissection