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Acute Myocardial Ischemia in Patients Receiving Surgery for Acute Type A Aortic Dissection
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  • Kuang-Hsin Tien,
  • Fan Peng,
  • Wan-Ying Koh,
  • Liang-Ying Ke,
  • Cing-Syue Lin,
  • Jiann-Woei Huang ,
  • Chong-Chao Hsieh,
  • Huai-Min Chen ,
  • Chee-Siong Lee,
  • Ying Fu Chen
Kuang-Hsin Tien
Kaohsiung Medical University School of Medicine
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Fan Peng
Taipei Tzu Chi Hospital
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Wan-Ying Koh
Kaohsiung Medical University School of Medicine

Corresponding Author:[email protected]

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Liang-Ying Ke
Kaohsiung Medical University School of Medicine
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Cing-Syue Lin
Kaohsiung Medical University School of Medicine
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Jiann-Woei Huang
Kaohsiung Medical University Chung Ho Memorial Hospital
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Chong-Chao Hsieh
Kaohsiung Medical University Chung Ho Memorial Hospital
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Huai-Min Chen
Kaohsiung Medical University Chung Ho Memorial Hospital
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Chee-Siong Lee
Kaohsiung Medical University Chung Ho Memorial Hospital
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Ying Fu Chen
Kaohsiung Medical University Chung Ho Memorial Hospital
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Abstract

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.