Acute Myocardial Ischemia in Patients Receiving Surgery for Acute Type A
Purpose: Acute type A aortic dissection (ATAAD) is a dissection
involving the ascending aorta within 14 days of symptom onset. Acute
myocardial ischemia is associated with short-term mortality in patients
with ATAAD. However, its relevance to ATAAD’s surgical timing and
prognostic implications is unknown. Methods: This retrospective
study enrolled 277 patients at our tertiary center between March 1997
and January 2019 and investigated their admission electrocardiograms.
Twenty-one patients with left ventricular hypertrophy or left bundle
branch block were excluded, and the records of 256 patients eventually
underwent data collection, review, and multivariate analysis.
Results: In patients with acute myocardial ischemia, the
incidence of aortic root involvement, acute coronary involvement, and
preoperative stroke was significantly higher. Acute myocardial ischemia
was unassociated with 30-day or in-hospital mortality in patients who
underwent surgery within 7 h of symptom onset. However, it was
independently associated with the 30-day mortality and postoperative
stroke when the 7-hour window had elapsed. Conclusions: As a
time-dependent surgical prognosticator in ATAAD, acute myocardial
ischemia was unassociated with short-term mortality in patients
surgically operated within 7 h of symptom onset. Conversely, it was an
independent factor for the 30-day mortality and postoperative stroke
when the 7-hour window had elapsed.