Risk factors of pre-operational aortic rupture in acute and subacute Stanford type A aortic dissection patients

Background: Aortic rupture is one of the main causes of early death in acute and subacute Stanford type A aortic dissection (ATAAD) patients. This study aimed to analyze potential risk factors for pre-operational aortic rupture in ATAAD patients. Methods: We retrospectively reviewed aortic dissection cases treated between May 2013 and May 2016 in Changhai Hospital, Shanghai. A total of 329 patients with ATAAD were included in the final analysis, and 31 patients died of aortic rupture before surgery. Clinical data on basic characteristics, clinical presentation, and biochemical measurements for all 329 patients were analyzed. Results: The in-hospital aortic rupture rate was 9.4% (31/329), and the rupture accounted for 47% (31/66) of all in-hospital deaths of ATAAD patients. Patients who experienced rupture were significantly older (P 0.7 ng/mL (OR: 9.28; 95% CI, 1.72–50.06; P=0.010), and D-dimer level ≥10 μg/mL (OR: 13.37; 95% CI, 2.18–81.97; P=0.005). Conclusions: Aortic rupture accounted for 47% of all in-hospital deaths among patient with ATAAD. Shock, pain requiring medication, a troponin level >0.7 ng/mL and a D-dimer level ≥10 μg/mL are independent risk factors for aortic rupture in these patients.