Acute Coronary Syndrome Secondary to Acute Aortic Dissection – Underlying Mechanisms and Possible Therapeutic Options

Hirata, Kazuhito; Hiratsuji, Tomoya; Wake, Minoru; Mototake, Hidemitsu

doi:10.5772/28407

Cited by 3 publications

(4 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These results were consistent with the data obtained by Pourafkari, which showed that troponin increase was not different in ATAAD patients with acute ECG changes [19]. The possible mechanism of this phenomenon might lie in that compromise of the coronary perfusion would be intermittent, incomplete, and variable when it was caused by coronary ostium obstruction of the local dissection ap instead of complete coronary detachment [18,20]. This hypothesis was also supported by our comparable incidence of CABG applied between the two groups, which was performed only in case of complete avulsion of the coronary artery [18,21].…”

Section: Discussionsupporting

confidence: 91%

Impact of unintentional coronary angiography on outcomes of emergency surgery in acute type A aortic dissection: a retrospective study

Peng

Liu²,

Jian³

et al. 2022

Preprint

View full text Add to dashboard Cite

Background: This study investigated the impact of coronary angiography on outcomes of emergency operation in acute type A aortic dissection (ATAAD) patients who were initially misdiagnosed as the acute coronary syndrome.Methods: From October 2016 to April 2019, 129 patients underwent surgery for ATAAD in our institution, including 21 patients (16.3%, CA group) who received preoperative coronary angiography without knowledge of the ATAAD, and the rest 108 did not (NCA group). Preoperative clinical characteristics, surgical mortality and postoperative complications were compared. Multivariable logistic regression was performed to confirm the independent prognostic factors for short-term and long-term outcomes.Results: Patients undergoing coronary angiography had higher prevalence of preoperative hypotension or shock (61.9% vs 35.2%, P=0.022), ischemic changes on electrocardiogram (66.7% vs 37.0%, P=0.012), platelet inhibition (ADP-induced inhibition 92.0% vs 46.0%, P=0.001), and coronary involvement (66.7% vs 30.6%, P=0.002). 30-day/in-hospital mortality was 4.8% versus 9.3% (P=0.84). CA group had more intraoperative bleeding (1900ml vs 1500ml, P=0.013) and chest-tube drainage on the first postoperative day (1040ml vs 595ml, P=0.028). However, preoperative coronary angiography was not independent risk factors for surgical mortality (OR 0.171, 95%CI 0.013-2.174, P=0.173) and overall survival (HR 0.407; 95%CI 0.080-2.057; P=0.277). Conclusion: Patients undergoing coronary angiography carried a higher risk of preoperative hemodynamic instability, myocardial ischemia, and perioperative bleeding. However, unintentional coronary angiography did not have a significant impact on short-term and long-term outcomes of emergency surgery in ATAAD.

show abstract

Section: Discussionsupporting

confidence: 91%

Impact of unintentional coronary angiography on outcomes of emergency surgery in acute type A aortic dissection: a retrospective study

Peng

Liu²,

Jian³

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…These findings were consistent with the results of Pourafkari, who found no difference in troponin increase in ATAAD patients with acute ECG changes [19]. The possible mechanism of this phenomenon might lie in that compromise of the coronary perfusion would be intermittent, incomplete, and variable when it was caused by coronary ostium obstruction of the local dissection flap instead of complete coronary detachment [18,20]. This hypothesis was also supported by our comparable incidence of CABG applied between the two groups, which was performed only in case of complete avulsion of the coronary artery [18,21].…”

Section: Discussionsupporting

confidence: 89%

Impact of unintentional coronary angiography on outcomes of emergency surgery in acute type A aortic dissection: a retrospective study

Peng

Liu²,

Jian³

et al. 2022

BMC Cardiovasc Disord

View full text Add to dashboard Cite

Background This study investigated the impact of coronary angiography on outcomes of emergency operation in acute type A aortic dissection (ATAAD) patients who were initially misdiagnosed as an acute coronary syndrome. Methods From October 2016 to April 2019, 129 patients underwent emergency operation for ATAAD in our institution, including 21 patients (16.3%, coronary angiography group) who received preoperative coronary angiography without knowledge of the ATAAD, and the rest 108 did not (Non-coronary angiography group). Preoperative clinical characteristics, 30-day mortality and postoperative complications were compared. Multivariable logistic regression was performed to confirm the independent prognostic factors for short-term and long-term outcomes. Results Patients undergoing coronary angiography had higher prevalence of preoperative hypotension or shock (61.9% vs 35.2%, P = 0.022), ischemic changes on electrocardiogram (66.7% vs 37.0%, P = 0.012), platelet inhibition (ADP-induced inhibition 92.0% vs 46.0%, P = 0.001), and coronary involvement (66.7% vs 30.6%, P = 0.002). 30-day mortality was 4.8% versus 9.3% (P = 0.84). Coronary angiography group had more intraoperative bleeding (1900 ml vs 1500 ml, P = 0.013) and chest-tube drainage on the first postoperative day (1040 ml vs 595 ml, P = 0.028). However, preoperative coronary angiography was not independent risk factors for 30-day mortality (OR 0.171, 95%CI 0.013–2.174, P = 0.173) and overall survival (HR 0.407; 95%CI 0.080–2.057; P = 0.277). Conclusion Patients undergoing coronary angiography carried a higher risk of preoperative hemodynamic instability, myocardial ischemia, and perioperative bleeding. However, unintentional coronary angiography did not have a significant impact on short-term and long-term outcomes of emergency surgery in ATAAD.

show abstract

“…Acute ST depression and T wave changes are rather common in the very acute phase of AAD [ 2 , 13 – 15 ] and are closely related to tamponade and shock rather than mechanical coronary malperfusion [ 13 ]. In the present study, acute ST depression and T wave changes were not a significant predictor for IID or DD.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, coronary malperfusion is a significant predictor of IID. If there are profound ECG changes suggestive of coronary malperfusion, such as ST elevation in inferior leads or diffuse ST depression and ST elevation of aVr [ 15 – 18 ], then misdiagnosis of classic acute myocardial infarction due to occlusion of the right coronary artery or left main trunk may be made instead of AAD, subjecting the patient to inappropriate therapy [ 19 – 22 ]. These observations are consistent with those of Rapezzi et al [ 8 ], who noted that an ACS-like ECG was a risk for DD.…”

Section: Discussionmentioning

confidence: 99%

Clinical Predictors for Delayed or Inappropriate Initial Diagnosis of Type A Acute Aortic Dissection in the Emergency Room

et al. 2015

Self Cite

View full text Add to dashboard Cite

BackgroundInitial diagnosis of acute aortic dissection (AAD) in the emergency room (ER) is sometimes difficult or delayed. The aim of this study is to define clinical predictors related to inappropriate or delayed diagnosis of Stanford type A AAD.MethodsWe conducted a retrospective analysis of 127 consecutive patients with type A AAD who presented to the ER within 12 h of symptom onset (age: 69.0 ± 15.4 years, male/female = 49/78). An inappropriate initial diagnosis (IID) was considered if AAD was not included in the differential diagnosis or if chest computed tomography or echocardiography was not performed as initial imaging tests. Clinical variables were compared between IID and appropriate diagnosis group. The time to final diagnosis (TFD) was also evaluated. Delayed diagnosis (DD) was defined as TFD > third quartile. Clinical factors predicting DD were evaluated in comparison with early diagnosis (defined as TFD within the third quartile). In addition, TFD was compared with respect to each clinical variable using a rank sum test.ResultsAn IID was determined for 37% of patients. Walk-in (WI) visit to the ER [odds ratio (OR) 2.6, 95% confidence interval (CI) = 1.01–6.72, P = 0.048] and coronary malperfusion (CM, OR = 6.48, 95% CI = 1.14–36.82, P = 0.035) were predictors for IID. Overall, the median TFD was 1.5 h (first/third quartiles = 0.5/4.0 h). DD (>4.5 h) was observed in 27 cases (21.3%). TFD was significantly longer in WI patients (median and first/third quartiles = 1.0 and 0.5/2.85 h for the ambulance group vs. 3.0 and 1.0/8.0 h for the WI group, respectively; P = 0.003). Multivariate analysis revealed that WI visit was the only predictor for DD (OR = 3.72, 95% CI = 1.39–9.9, P = 0.009). TFD was significantly shorter for appropriate diagnoses than for IIDs (1.0 vs. 6.0 h, respectively; P < 0.0001).ConclusionsWI visit to the ER and CM were predictors for IID, and WI was the only predictor for DD in acute type A AAD in the community hospital.

show abstract

Acute Coronary Syndrome Secondary to Acute Aortic Dissection – Underlying Mechanisms and Possible Therapeutic Options

Cited by 3 publications

References 18 publications

Impact of unintentional coronary angiography on outcomes of emergency surgery in acute type A aortic dissection: a retrospective study

Impact of unintentional coronary angiography on outcomes of emergency surgery in acute type A aortic dissection: a retrospective study

Impact of unintentional coronary angiography on outcomes of emergency surgery in acute type A aortic dissection: a retrospective study

Clinical Predictors for Delayed or Inappropriate Initial Diagnosis of Type A Acute Aortic Dissection in the Emergency Room

Contact Info

Product

Resources

About