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Characteristics and in-hospital outcomes of patients with cardiac tamponade complicating type A acute aortic dissection.

Publication ,  Journal Article
Gilon, D; Mehta, RH; Oh, JK; Januzzi, JL; Bossone, E; Cooper, JV; Smith, DE; Fang, J; Nienaber, CA; Eagle, KA; Isselbacher, EM ...
Published in: Am J Cardiol
April 1, 2009

Cardiac tamponade (TMP) is a life-threatening complication of acute type A aortic dissection (AAD). The purpose of this study was to assess the clinical characteristics and in-hospital outcomes of TMP in the setting of AAD on the basis of the findings in the large cohort of the International Registry of Acute Aortic Dissection (IRAD). Six hundred seventy-four patients (mean age 61.8 +/- 14.2 years) with AAD in IRAD were studied. TMP was suspected on clinical grounds and confirmed by diagnostic imaging. Univariate testing was followed by multivariate logistic regression analysis to determine the association of TMP. TMP was detected in 126 patients with AAD (18.7%). Age did not differ between patients with and without TMP. Those with TMP less often had previous cardiac surgery (7.0% vs 17.1%, p = 0.007). Syncope (37.8% vs 13.7%, p <0.0001) and altered mental status (31.2% vs 10.6%, p <0.0001) were more common in patients with AAD with TMP than without TMP. Patients with TMP were more likely to have widened mediastina on chest x-ray (72.6% vs 60.3%, p = 0.02) and to have periaortic hematomas (44.7% vs 21.2%, p <0.0001). In-hospital outcomes were significantly worse in patients with TMP. The mortality of patients with TMP remained significantly higher, even after adjustment for baseline clinical characteristics (p <0.001). On logistic regression, altered mental status, hypotension, and early mortality were identified as independent correlates of TMP. In conclusion, TMP is not uncommon in patients with AAD. Syncope, altered mental status, and a widened mediastinum on chest x-ray on presentation suggest TMP, the presence of which warrants urgent operative therapy to improve outcome.

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Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

April 1, 2009

Volume

103

Issue

7

Start / End Page

1029 / 1031

Location

United States

Related Subject Headings

  • Sex Distribution
  • Retrospective Studies
  • Registries
  • Radiography, Thoracic
  • Prognosis
  • Middle Aged
  • Male
  • Inpatients
  • Incidence
  • Humans
 

Citation

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Gilon, D., Mehta, R. H., Oh, J. K., Januzzi, J. L., Bossone, E., Cooper, J. V., … International Registry of Acute Aortic Dissection Group, . (2009). Characteristics and in-hospital outcomes of patients with cardiac tamponade complicating type A acute aortic dissection. Am J Cardiol, 103(7), 1029–1031. https://doi.org/10.1016/j.amjcard.2008.12.013
Gilon, Dan, Rajendra H. Mehta, Jae K. Oh, James L. Januzzi, Eduardo Bossone, Jeanna V. Cooper, Dean E. Smith, et al. “Characteristics and in-hospital outcomes of patients with cardiac tamponade complicating type A acute aortic dissection.Am J Cardiol 103, no. 7 (April 1, 2009): 1029–31. https://doi.org/10.1016/j.amjcard.2008.12.013.
Gilon D, Mehta RH, Oh JK, Januzzi JL, Bossone E, Cooper JV, et al. Characteristics and in-hospital outcomes of patients with cardiac tamponade complicating type A acute aortic dissection. Am J Cardiol. 2009 Apr 1;103(7):1029–31.
Gilon, Dan, et al. “Characteristics and in-hospital outcomes of patients with cardiac tamponade complicating type A acute aortic dissection.Am J Cardiol, vol. 103, no. 7, Apr. 2009, pp. 1029–31. Pubmed, doi:10.1016/j.amjcard.2008.12.013.
Gilon D, Mehta RH, Oh JK, Januzzi JL, Bossone E, Cooper JV, Smith DE, Fang J, Nienaber CA, Eagle KA, Isselbacher EM, International Registry of Acute Aortic Dissection Group. Characteristics and in-hospital outcomes of patients with cardiac tamponade complicating type A acute aortic dissection. Am J Cardiol. 2009 Apr 1;103(7):1029–1031.
Journal cover image

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

April 1, 2009

Volume

103

Issue

7

Start / End Page

1029 / 1031

Location

United States

Related Subject Headings

  • Sex Distribution
  • Retrospective Studies
  • Registries
  • Radiography, Thoracic
  • Prognosis
  • Middle Aged
  • Male
  • Inpatients
  • Incidence
  • Humans