CTA Imaging Features and Prognosis in Emergency Type A Aortic Dissection Admissions

Abstract

Abstract Background Acute Type A aortic dissection (ATAAD) is a life-threatening condition requiring prompt surgical intervention. This retrospective study aimed to identify preoperative computed tomography angiography (CTA) features associated with in-hospital mortality in ATAAD patients. We examined specific CTA characteristics and their implications for patient outcomes. Methods We conducted a retrospective analysis of 384 patients diagnosed with ATAAD who underwent emergency surgery at Nanjing Drum Tower Hospital between March 2019 and March 2022. Their pre-admission CTA images were interpreted by experienced radiologists. The patients were divided into two groups: the survival group and the mortality group. We used logistic regression to assess the impact of various CTA features finding on in-hospital mortality rates between these two groups. Results Our study revealed significant associations between specific CTA findings and in-hospital mortality in ATAAD patients. Notably, the absence of visible fenestration (OR = 2.296, 95% CI: 1.005–5.245, P = 0.049), involvement of the superior mesenteric artery (OR = 4.805, 95% CI: 1.977–11.677, P < 0.001), a total ascending aortic diameter ≥ 4.7 cm (OR = 3.040, 95% CI: 1.326–6.970, P = 0.009), and the presence of multiple tears (OR = 0.094, 95% CI: 0.012–0.717, P = 0.022) were linked to mortality risk. These associations held true even after adjusting for potential confounders in multivariable analyses. The logistic regression model demonstrated good discriminative ability with an area under the ROC curve of 0.726. Conclusion In conclusion, this study identified preoperative CTA features that can help predict in-hospital mortality in ATAAD patients. The absence of visible fenestration and involvement of the superior mesenteric artery, a total ascending aortic diameter ≥ 4.7 cm, the presence of multiple tears were significant risk factors. These findings emphasize the importance of careful assessment and consideration of these CTA characteristics when managing ATAAD patients. Future research should explore additional factors and consider multicenter, prospective studies for a more comprehensive understanding of ATAAD prognosis and treatment strategies. Trial registration The study received approval from the ethical committees of Nanjing Drum Tower Hospital (No.2022-157-01) and individual consent for this retrospective analysis was waived.