Stroke and Outcomes in Patients With Acute Type A Aortic Dissection

Abstract

Background— Stroke is a highly dreaded complication of type A acute aortic dissection (TAAAD). However, little data exist on its incidence and association with prognosis. Methods and Results— We evaluated 2202 patients with TAAAD (mean age 62±14 years, 1487 [67.5%] men) from the International Registry of Acute Aortic Dissection to determine the incidence and prognostic impact of stroke in TAAAD. Stroke was present at arrival in 132 (6.0%) patients with TAAAD. These patients were older (65±12 versus 62±15 years; P =0.002) and more likely to have hypertension (86% versus 71%; P =0.001) or atherosclerosis (29% versus 22%; P =0.04) than patients without stroke. Chest pain at arrival was less common in patients with stroke (70% versus 82%; P <0.001), and patients with stroke presented more often with syncope (44% versus 15%; P <0.001), shock (14% versus 7%; P =0.005), or pulse deficit (51% versus 29%; P ≤0.001). Arch vessel involvement was more frequent among patients with stroke (68% versus 37%; P <0.001). They had less surgical management (74% versus 85%; P <0.001). Hospital stay was significantly longer in patients with stroke (median 17.9 versus 13.3 days; P <0.001). In-hospital complications, such as hypotension, coma, and malperfusion syndromes, and in-hospital mortality (adjusted odds ratio, 1.62; 95% confidence interval, 0.99–2.65) were higher among patients with stroke. Among hospital survivors, follow-up mortality was similar between groups (adjusted hazard ratio, 1.15; 95% confidence interval, 0.46–2.89). Conclusions— Stroke occurred in >1 of 20 patients with TAAAD and was associated with increased in-hospital morbidity but not long-term mortality. Whether aggressive early invasive interventions will reduce negative outcomes remains to be evaluated in future studies.