Acil servise başvuran akut aort diseksiyonlu hastalarda mortaliteyi etkileyen faktörlerin analizi
Year 2025,
Volume: 7 Issue: 2, 19 - 24, 01.09.2025
Ramazan Sami Aktaş
,
İdris Tüzün
,
Ayşe Ertekin
,
Şahin Şahinalp
Abstract
Amaç: Akut aort diseksiyonu yaşamı tehdit eden kardiyovasküler bir acil durumdur. Diseksiyon, aorttaki tutulum yerine göre farklı klinik tablolarla acil servise başvurabilir. Tanı ve tedavideki gecikmeler mortalite oranlarını artırabileceğinden mortaliteyi etkileyen faktörlerin bilinmesi son derece önemlidir. Bu çalışmadaki amacımız mortalite oranlarını etkileyebilecek faktörleri değerlendirmektir.
Gereç ve Yöntemler: Veri tabanından bin iki yüz seksen üç hasta analiz edildi. 48 hastada kesin akut aort diseksiyonu tanısı konuldu. İki hasta gönüllü olarak tedaviyi reddetti ve acil servisten ayrıldı. Verilerin analizinde SPSS 27.0 programı kullanıldı. Verilerin istatistiksel anlamlılığı için p değeri analiz edildi.
Bulgular: Hastaların demografik verileri, yaşı, cinsiyeti, acil servise başvuru şikayetleri, şikayetlerin başlama zamanı, tanı süresi, görüntüleme ve laboratuvar değerlerinin mortalite üzerine etkisi değerlendirildi. Böbrek yetmezliğinin, özellikle senkop ve komorbid durumlarda ilk başvuru anında mortalite ile ilişkili olduğu sonucuna vardık.
Sonuç: Başvuru yakınması olan senkop ve eşlik eden hastalıklardan böbrek yetmezliğinin mortaliteyi arttırdığı değerlendirildi. Diğer verilerimiz istatistiksel olarak anlamlı olmasa da önemli farklılıklar içermektedir. Daha büyük veri analizleri, risk faktörlerinin belirlenmesine yardımcı olacaktır.
References
-
Koechlin L, Schuerpf J, Bremerich J, Sommer G, Gahl B, Reuthebuch O, et al. Acute aortic dissection with entry tear at the aortic arch: Long-term outcome. Interact Cardiovasc Thorac Surg. 2021;32(1):89-96. doi:10.1093/icvts/ivaa228
-
Gawinecka J, Schönrath F, von Eckardstein A. Acute aortic dissection: pathogenesis, risk factors and diagnosis. Swiss Med Wkly. 2017;147:w14489. doi:10.4414/smw.2017.14489
-
Tsai TT, Trimarchi S, Nienaber CA. Acute aortic dissection: perspectives from the International Registry of Acute Aortic Dissection (IRAD). Eur J Vasc Endovasc Surg. 2009;37(2):149-159. doi:10.1016/j.ejvs.2008.11.032
-
Wundram M, Falk V, Eulert-Grehn JJ, Herbst H, Thurau J, Leidel BA, et al. Incidence of acute type A aortic dissection in emergency departments. Sci Rep. 2020;10(1):7434. doi:10.1038/s41598-020-64299-4
-
Harris KM, Strauss CE, Eagle KA, Hirsch AT, Isselbacher EM, Tsai TT, et al. Correlates of delayed recognition and treatment of acute type A aortic dissection: The international registry of acute aortic dissection (IRAD). Circulation. 2011;124(18):1911-1918. doi:10.1161/CIRCULATIONAHA.110.006320
-
Zaschke L, Habazettl H, Thurau J, Matschilles C, Göhlich A, Montagner M, et al. Acute type A aortic dissection: Aortic Dissection Detection Risk Score in emergency care – surgical delay because of initial misdiagnosis. Eur Heart J Acute Cardiovasc Care. 2020;9(3_suppl):S40-S47. doi:10.1177/2048872620914931
-
Nienaber CA, Clough RE. Management of acute aortic dissection. Lancet. 2015;385(9970):800-811. doi:10.1016/S0140-6736(14)61005-9
-
Bossone E, Eagle KA. Epidemiology and management of aortic disease: aortic aneurysms and acute aortic syndromes. Nat Rev Cardiol. 2021;18(5):331-348. doi:10.1038/s41569-020-00472-6
-
Hansen MS, Nogareda GJ, Hutchison SJ. Frequency of and inappropriate treatment of misdiagnosis of acute aortic dissection. Am J Cardiol. 2007;99(6):852-856. doi:10.1016/j.amjcard.2006.10.055
-
Booher AM, Isselbacher EM, Nienaber CA, Trimarchi S, Evangelista A, Montgomery DG, et al. The IRAD classification system for characterizing survival after aortic dissection. Am J Med. 2013;126(8):730.e19-730.e7.3E24. doi:10.1016/j.amjmed.2013.01.020
-
Trimarchi S, Eagle KA, Nienaber CA, Rampoldi V, Jonker FHW, de Vincentiis C, et al. Role of age in acute type A aortic dissection outcome: Report from the International Registry of Acute Aortic Dissection (IRAD). J Thorac Cardiovasc Surg. 2010;140(4):784-789. doi:10.1016/j.jtcvs.2009.11.014
-
Chen X, Bai M, Sun S, Chen X. Outcomes and risk management in type B aortic dissection patients with acute kidney injury: a concise review. Ren Fail. 2021;43(1):585-596. doi:10.1080/0886022X.2021.1905664
-
Suzuki T, Bossone E, Sawaki D, Jánosi RA, Erbel R, Eagle K, et al. Biomarkers of aortic diseases. Am Heart J. 2013;165(1):15-25. doi:10.1016/j.ahj.2012.10.006
Analysis of Factors Affecting Mortality in Patients with Acute Aortic Dissection Admitted to the Emergency Department
Year 2025,
Volume: 7 Issue: 2, 19 - 24, 01.09.2025
Ramazan Sami Aktaş
,
İdris Tüzün
,
Ayşe Ertekin
,
Şahin Şahinalp
Abstract
Aim: Acute aortic dissection is a life-threatening cardiovascular emergency. The dissection may be admitted to the emergency department with different clinical pictures, depending on the place of involvement in the aorta. It is extremely important to know the factors affecting mortality, as delays in diagnosis and treatment can increase mortality rates. Our aim of this study is to evaluate the factors that may affect mortality rates.
Materials and Methods: One thousand two hundred and eighty-three patients were analyzed from the database. A definitive diagnosis of acute aortic dissection was identified in 48 patients. Two patients voluntarily refused treatment and left the emergency department. SPSS 27.0 program was used for data analysis. The p value was analyzed for the statistical significance of the data.
Results: The effects of patients' demographic data, age, gender, complaints on admission to the emergency department, onset time of complaints, duration of diagnosis, imaging and laboratory values on mortality were evaluated. We concluded that renal failure is associated with mortality at the time of first admission, especially in syncope and comorbid conditions.
Conclusion: It was evaluated that syncope, one complaint at admission, and renal failure, one of the accompanying diseases, increased mortality. Although our other data are not statistically significant, they contain significant differences. Bigger data analyzes will help identify risk factors.
Ethical Statement
Ethical approval for this study was obtained from Van Yüzüncü Yıl University Hospital Ethics Committee (Decision no:2021/02-20, date:12.02.2021)
References
-
Koechlin L, Schuerpf J, Bremerich J, Sommer G, Gahl B, Reuthebuch O, et al. Acute aortic dissection with entry tear at the aortic arch: Long-term outcome. Interact Cardiovasc Thorac Surg. 2021;32(1):89-96. doi:10.1093/icvts/ivaa228
-
Gawinecka J, Schönrath F, von Eckardstein A. Acute aortic dissection: pathogenesis, risk factors and diagnosis. Swiss Med Wkly. 2017;147:w14489. doi:10.4414/smw.2017.14489
-
Tsai TT, Trimarchi S, Nienaber CA. Acute aortic dissection: perspectives from the International Registry of Acute Aortic Dissection (IRAD). Eur J Vasc Endovasc Surg. 2009;37(2):149-159. doi:10.1016/j.ejvs.2008.11.032
-
Wundram M, Falk V, Eulert-Grehn JJ, Herbst H, Thurau J, Leidel BA, et al. Incidence of acute type A aortic dissection in emergency departments. Sci Rep. 2020;10(1):7434. doi:10.1038/s41598-020-64299-4
-
Harris KM, Strauss CE, Eagle KA, Hirsch AT, Isselbacher EM, Tsai TT, et al. Correlates of delayed recognition and treatment of acute type A aortic dissection: The international registry of acute aortic dissection (IRAD). Circulation. 2011;124(18):1911-1918. doi:10.1161/CIRCULATIONAHA.110.006320
-
Zaschke L, Habazettl H, Thurau J, Matschilles C, Göhlich A, Montagner M, et al. Acute type A aortic dissection: Aortic Dissection Detection Risk Score in emergency care – surgical delay because of initial misdiagnosis. Eur Heart J Acute Cardiovasc Care. 2020;9(3_suppl):S40-S47. doi:10.1177/2048872620914931
-
Nienaber CA, Clough RE. Management of acute aortic dissection. Lancet. 2015;385(9970):800-811. doi:10.1016/S0140-6736(14)61005-9
-
Bossone E, Eagle KA. Epidemiology and management of aortic disease: aortic aneurysms and acute aortic syndromes. Nat Rev Cardiol. 2021;18(5):331-348. doi:10.1038/s41569-020-00472-6
-
Hansen MS, Nogareda GJ, Hutchison SJ. Frequency of and inappropriate treatment of misdiagnosis of acute aortic dissection. Am J Cardiol. 2007;99(6):852-856. doi:10.1016/j.amjcard.2006.10.055
-
Booher AM, Isselbacher EM, Nienaber CA, Trimarchi S, Evangelista A, Montgomery DG, et al. The IRAD classification system for characterizing survival after aortic dissection. Am J Med. 2013;126(8):730.e19-730.e7.3E24. doi:10.1016/j.amjmed.2013.01.020
-
Trimarchi S, Eagle KA, Nienaber CA, Rampoldi V, Jonker FHW, de Vincentiis C, et al. Role of age in acute type A aortic dissection outcome: Report from the International Registry of Acute Aortic Dissection (IRAD). J Thorac Cardiovasc Surg. 2010;140(4):784-789. doi:10.1016/j.jtcvs.2009.11.014
-
Chen X, Bai M, Sun S, Chen X. Outcomes and risk management in type B aortic dissection patients with acute kidney injury: a concise review. Ren Fail. 2021;43(1):585-596. doi:10.1080/0886022X.2021.1905664
-
Suzuki T, Bossone E, Sawaki D, Jánosi RA, Erbel R, Eagle K, et al. Biomarkers of aortic diseases. Am Heart J. 2013;165(1):15-25. doi:10.1016/j.ahj.2012.10.006