Early risk factors in acute type A aortic dissection: is there a predictorof preoperative mortality?

Background To describe the preoperative clinical, echocardiographic and bio logical findings in patients with acute aortic dissection and attempt to sp ecify high risk factors of preoperative mortality. Methods. A retrospective, monocentric study of 148 patients admitted for ac ute type A aortic dissection. All patients underwent a clinical, echocardio graphic and biological evaluation on admission. In 75 patients, we measured serum cardiac troponin I (cTnI). Results. In hospital mortality was 25.9% and 15.6% presented with preoperat ive cardiac circulatory arrest (POCCA). Patients with POCCA were more likel y than others to have hypotension (97 +/- 56 vs 144 +/- 24 mmHg, p <0.01) o r shock (52% vs 3%, p <0.01) on admission. Pericardial effusion (65% vs 35% , p=0.01) and tamponade (61% tis 8%, p <0.01) were also significantly linke d to POCCA but not the aortic ascendant diameter. Detection of cTnI was mor e frequent in patients with POCCA (24% vs 7%, p=0.051) and was found to be a good predictor of in hospital mortality (47% vs 14%, p <0.01). Conclusions. For patients with acute type A aortic dissection, hypotension or shock on admission, pericardial effusion or tamponade, as well as cTnI d etection, were the main predictors for POCCA and imply immediate surgery.