Acute Aortic Disease.. - Index of

16 Nienaber and Ince
(A)
(B)
Probability of Death (%)
90
80
70
60
50
40
30
20
10
0
0
= Observed
= Model
0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0
Model Score
Score p Death OR (95 % CI)
Age 70 a
0.5 0.03 1.70 (1.05–2.77)
female 0.3 0.20 1.38 (0.85–2.27)
sudden chest pain 1.0 0.01 2.60 (1.22–5.54)
pathological ECG 0.6 0.03 1.77 (1.06–2.95)
pulse deficit 0.7 0.004 2.03 (1.25–3.29)
ARF 1.6 0.002 4.77 (1.80–12.6)
Hypotension Shock/
Tamponade
1.1 < 0.0001 2.97 (1.83–4.81)
Figure 8 Observed versus predicted mortality for acute type A aortic dissection based
on a risk score; each risk factor was statistically extracted from retrospective analysis in
International Registry of Acute Aortic Dissection (IRAD) and then prospectively confirmed.
Both predicted and observed mortality rates in IRAD increase with increasing number and
weight of risk factors. Abbreviations: ARF, acute renal failure; CI, confidence interval;
ECG, electrocardiogram. Source: From Ref. 40.
a pulse differential, sudden onset of renal failure or abdominal pain (Fig. 9). These
patients have a 3.5 times higher risk of death than patients without these features.
Overall, in distal dissection, the in-hospital mortality averages around 13%,
with most fatalities occurring within the first week after onset. Additional factors
associated with increased in-hospital mortality include hypotension and shock,
a widened mediastinum, periaortic hematoma, an excessively dilated descending
aorta (≥6 cm), and need for surgical management (all P < 0.05). A risk prediction
model controlling for age and gender showed hypotension/shock [odds ratio
(OR) 23.8; P < 0.0001], absence of chest/back pain on presentation (OR 3.5;
P = 0.01), and branch vessel involvement (OR 2.9; P = 0.02), collectively named
“the deadly triad,” to be independent predictors of in-hospital death even in distal
aortic dissection (74). These factors associated with increased in-hospital mortality