International journal of cardiology · 2025
Clinical characteristics and outcomes of acute type A aortic dissection in out-of-hospital cardiac arrest patients: A retrospective study.
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Kirihara Shihomi, Kawakami Shoji, Koga Hidenobu, Nawata Eigo, Matsumoto Yosuke, Tamura Chikako, Takei Masato, Ota Yoshihiro, Sasamoto Hikaru, Miura Nobutoshi, Yamada Tetsuhisa, Nishi Jun-Ichiro
Аннотация
BACKGROUND: Acute type A aortic dissection (AAAD) is a critical cause of out-of-hospital cardiac arrest (OHCA). While non-contrast computed tomography (CT) has recently been reported as effective for diagnosing AAAD in OHCA patients, the proportion of OHCA cases due to AAAD and their clinical characteristics remain unclear. This study aimed to investigate these factors in patients transported to our hospital.
METHODS AND RESULTS: This single-center retrospective study included 985 non-traumatic adult OHCA patients who underwent non-contrast CT between June 2017 and December 2022. Patients were categorized into three groups: cardiac causes (Group-C), non-cardiac causes without AAAD (Group-NC), and AAAD (Group-AAAD). Clinical characteristics and CT findings were analyzed. Multivariate logistic regression identified predictors of AAAD-related OHCA. Among 985 patients, 763 (77 %) were in Group-C, 136 (14 %) in Group-NC, and 86 (8 %) in Group-AAAD. The prevalence of return of spontaneous circulation (ROSC) was significantly lower in Group-AAAD than in Group-C and Group-NC (8 % vs. 27 % vs. 33 %, p < 0.001). Female sex (OR 4.21, p < 0.001), witnessed arrest (OR 2.06, p = 0.003), non-shockable rhythm (OR 3.06, p = 0.042), and absence of ROSC (OR 4.95, p < 0.001) were independent predictors of AAAD-related OHCA.
CONCLUSIONS: AAAD should be considered in OHCA patients, especially females with witnessed arrest, non-shockable rhythms, and no ROSC. Recognizing these factors may aid in early diagnosis and improve clinical decision-making in emergency settings.
METHODS AND RESULTS: This single-center retrospective study included 985 non-traumatic adult OHCA patients who underwent non-contrast CT between June 2017 and December 2022. Patients were categorized into three groups: cardiac causes (Group-C), non-cardiac causes without AAAD (Group-NC), and AAAD (Group-AAAD). Clinical characteristics and CT findings were analyzed. Multivariate logistic regression identified predictors of AAAD-related OHCA. Among 985 patients, 763 (77 %) were in Group-C, 136 (14 %) in Group-NC, and 86 (8 %) in Group-AAAD. The prevalence of return of spontaneous circulation (ROSC) was significantly lower in Group-AAAD than in Group-C and Group-NC (8 % vs. 27 % vs. 33 %, p < 0.001). Female sex (OR 4.21, p < 0.001), witnessed arrest (OR 2.06, p = 0.003), non-shockable rhythm (OR 3.06, p = 0.042), and absence of ROSC (OR 4.95, p < 0.001) were independent predictors of AAAD-related OHCA.
CONCLUSIONS: AAAD should be considered in OHCA patients, especially females with witnessed arrest, non-shockable rhythms, and no ROSC. Recognizing these factors may aid in early diagnosis and improve clinical decision-making in emergency settings.