Background: Performing preoperative coronary angiography (CA) before surgical repair of a type A acute aortic dissection (TA-AAD) remains controversial. Although the information provided by CA may be useful in planning the surgical approach, the potential delay to surgery and complications of CA may confer added risk of death before definitive repair of the aorta. Methods: We analyzed 1,343 patients from January 27, 1996, to May 3, 2010, with TA-AAD from the International Registry of Acute Aortic Dissection who underwent surgical or endovascular repair during the index hospitalization, with (n = 156) or without (n = 1,187) preoperative CA. The main outcomes measured were in-hospital complications and in-hospital and long-term mortality. Results: Patients who underwent preoperative CA were more likely to have a history of atherosclerosis and present with electrocardiographic signs of myocardial ischemia/infarction. In the preoperative CA group, significant delays from the onset of symptoms to the time of surgery occurred. In-hospital postoperative complications and mortality rates were largely similar between the 2 groups. On multivariable logistic regression analysis, preoperative CA had no significant effect on in-hospital risk-adjusted mortality when compared to the validated International Registry of Acute Aortic Dissection risk score. Long-term mortality was similar between patients receiving preoperative CA and those who did not; long-term rehospitalization rates were higher, although largely insignificantly, among preoperative CA recipients through 5 years of follow-up. Conclusions: Preoperative CA is infrequently performed on patients with TA-AAD, except, occasionally, on patients at high risk for myocardial ischemia. When performed, preoperative CA was not associated with any significant changes in in-hospital and long-term mortality.
Bibliographical noteFunding Information:
Univariate analyses between the patient cohorts were performed using χ 2 analysis or Fisher exact test, where appropriate, for categorical data and Student t test for continuous variables. All P values were 2-sided, with values <.05 considered statistically significant. Subgroup analysis was performed to determine which patient characteristics were associated with in-hospital mortality. Finally, a propensity-matched data set was created to minimize the possible confounding effects on outcomes created by the underlying differences between patients receiving or not receiving CA, and a multivariable model predicting mortality was created using a multiple logistic regression to determine if CA was an independent predictor of in-hospital risk-adjusted mortality. This model included adjustment for an IRAD mortality risk score computed using the published IRAD mortality risk model, which is a validated tool used to predict in-hospital mortality for TA-AAD based on 7 variables (age ≥70 years, female gender, abrupt onset of chest pain, hypotension/shock/tamponade, renal failure, presence of any pulse deficits, and abnormal electrocardiogram [ECG]). 10 The analyses were performed using PASW 18.0 statistical analysis software (SPSS Inc, Chicago, IL) and SAS 8.2 (SAS Institute, Cary, NC). International Registry of Acute Aortic Dissection is supported by grants from the University of Michigan Health System; the Varbedian Fund for Aortic Research, Bloomfield Hills, MI; the Mardigian Foundation; and Gore, Inc, Flagstaff, AZ.
International Registry of Acute Aortic Dissection is supported by grants from the University of Michigan Health System, the Varbedian Fund for Aortic Research, the Mardigian Foundation, the Hewlett Foundation, and Gore, Inc.
Copyright 2018 Elsevier B.V., All rights reserved.